Efficacy observation between subpial cerebellar tonsillectomy and dural expansion repair on Chiari Ⅰ malformation with syringomyelia

English Keywords:Excision of cerebellar tonsillar hernia  Chiari type Ⅰ malformation  Syringomyelia  Posterior fossa decompression

English Abstract:

  【Abstract】 Objectives: To observe the postoperative effect and prognosis of subpial cerebellar tonsillectomy and dural expansion repair in the treatment of Chiari I malformation with syringomyelia, and to provide clinical evidence for decision making in clinical practice. Methods: From November 2013 to November 2016, the clinical data of 115 cases with Chiari I malformation that treated in our hospital were retrospectively analyzed, including 34 males and 81 females. The mean age was 42.3±11.3 years old(range, 16 to 60 years). There were 49 cases with syringomyelia, 58 cases with nerve stimulation in occipital foramen magnum, 9 cases with compression of cervico-medullary, 25 cases with dysfunction of posterior cranial nerve and cerebella, and 24 cases with high intracranial pressure. There were 26 cases of syringomyelia with cervical segments involvement, 85 cases with thoracic section involvement, 4 cases with waist involvement, 3 cases were associated with hydrocephalus, and 2 cases were combined with scoliosis inthoracic segments. Among them, 78 cases treated with posterior fossa decompression and lower cerebellar hernia tonsillectomy and the mucous membrane excision of the 4th ventricle outflow tract(group A), and 37 cases adopted occipital foramen magnum decompression and dural angioplasty(group B). The hospitalization time, intraoperative blood loss, postoperative complications, 6 months postoperative imaging features, Klekamp nerve score, and clinical symptoms were recorded. Results: The operation time of group A(159.32±40.06min) was higher than that of group B(134.10±30.76min)(P<0.05). Postoperatively, there were 11 and 8 cases respectively in group A and B with fever, 3 cases and 1 case with subcutaneous effusion, and 3 cases and 2 cases with incision infection. The incidence of dizziness and headache in group A postoperatively was 20 cases, which was higher than that of group B, 3 cases(P<0.05). There was no significant difference of overall complication between the two groups (P>0.05). There was 1 point change in postoperative pain, sensory disturbances, ataxia under Klekamp nerve score, and there appeared poor improvement in dyskinesia; a total of 69 patients(88.4%) with alleviated symptoms in group A, and 31(83.8%) in group B. There was no significant difference in neurological score or the improvement of clinical manifestations between the two groups(P>0.05). Also, there were 54 and 29 cases respectively with reduced cavity after operation, 22 and 7 cases without changes, 2 cases and 1 case with expansion, and there was no significant difference between the two groups in the cavity changes after operation(P<0.05). Conclusions: The effect of subpial cerebellar tonsillectomy in the treatment of Chiari I malformation with syringomyelia is not significantly different from that of dural expansion repair, but the operation time is long and the incidence of dizziness and headache after operation is high.