Clinical application of guiding the surgical strategy of Chiari malformation type I (CM-I) based on preoperative AIC scoring system

doi:10.19854/j.cnki.1008-2425.2021.06.0001

Abstract

Abstract: Objective To establish a simple adult Chiari malformation type I (CM-I) preoperative scoring system and explore its clinical value.Methods A retrospective analysis of 79 adult CM-I patients undergoing surgery in our department from January 2016 to December 2019.All patients were evaluated using the CM-I preoperative AIC scoring system,and the corresponding operations were performed based on the evaluation results.Surgical complications were recorded.MR was followed up post-surgery and the patients' outcome was evaluated by the Chicago Chiari prognostic score.Results All patients were discharged from the hospital without death.None of the patients with bone decompression alone had any postoperative complications.The CSF-related complications including postoperative headache with fever (12cases) and incision cerebrospinal fluid leakage (1 cases) are the most common complications in the patients underwent subdural decompression and subarachnoid decompression.All patients were cured by adjusting antibiotics,combined with drainage of the lumbar cistern when necessary.73 patients were successfully followed up post-surgery in 6-45 months.The CCOS was used to calculate the symptom improvement rate,and the result was 92.6%.MR follow-up showed 3 cases had no change in the syringomyelia,mild progress in one case.To varying degrees,the syringomyelia decreased or even disappeared in the rest of the patients compared with the preoperative MR.Conclusion Considering the safety and effectiveness of surgery,the individual operation method based on preoperative AIC scoring system is effective in clinical practice.

Key words: Chiari malformation type I, Syringomyelia, Preoperative evaluation, Operation method

摘要： 目的建立一个简单的成人Chiari-I型畸形术前评分系统并探讨其临床应用价值。方法回顾性分析2016年1月至2019年12月在我科接受手术的79例成人Chiari-I型畸形患者。术前应用AIC(age,imaging,clinical manifestations)评分系统行术前评估,依据评分选择相应的手术方式。记录患者手术并发症的发生率并行门诊及影像学随访,了解脊髓空洞转归,并应用芝加哥Chiari预后评分(Chicago chiari outcome scale,CCOS)系统评价手术疗效。结果患者均顺利出院,无死亡病例。单纯硬膜外减压患者术后未出现手术并发症。硬膜下减压最多见的并发症为脑脊液相关并发症,包括术后头痛伴发热(12例)、切口脑脊液漏(1例),所有患者均通过调整抗生素,必要时联合腰大池置管引流治愈。术后成功随访73例患者,随访时间为6~45个月。应用CCOS计算症状改善率,结果为92.6%;MR随访提示术前伴有脊髓空洞的患者有1例空洞较术前略有进展,3例脊髓空洞无变化,余患者脊髓空洞较术前均有不同程度的减小甚至消失。结论应用CM-I术前评分选择个体化的手术方式,安全有效,临床应用效果确切。

关键词: Chiari-I型畸形, 脊髓空洞症, 术前评估, 手术方式

CLC Number:

R744.4

Liu Jiang, Niu Chaoshi, Ling Shiying, et al.. Clinical application of guiding the surgical strategy of Chiari malformation type I (CM-I) based on preoperative AIC scoring system[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2021, 34(6): 321-325.

刘将, 牛朝诗, 凌士营, 夏成雨, 徐昊, 贾力, 王林, 傅先明. 成人Chiari-I型畸形的AIC评分及其在术式选择上的应用[J]. 立体定向和功能性神经外科杂志, 2021, 34(6): 321-325.

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