PDF(Pubmed)
Abstract：
BACKGROUND: The role of reduced intracranial compliance (ICC) in the outcome after foramen magnum decompression (FMD) was demonstrated in adults with Chiari malformation Type 1 (CMI). However, similar observations from children treated for CMI are missing.
METHODS: We reviewed pediatric cases of CMI referred to FMD between 2006 and 2022. Children with clinical and/or radiological signs suggesting reduced ICC (Group A) underwent overnight measurements of the pulsatile intracranial pressure (ICP): mean ICP wave amplitude (MWA) served as a surrogate marker of ICC. Children with more typical symptoms of CMI (Group B) underwent FMD without preoperative ICC estimation. This study presents the clinical, radiological, and outcome differences between these groups.
RESULTS: Sixty-four children (mean age 11.1 ± 4.3 years) underwent FMD: In Group A (n = 30), the finding of reduced ICC as estimated from preoperative ICP measurement resulted in CSF diversion (ventriculoperitoneal shunt) before FMD in 11 children. Two patients required shunt due to complications after FMD (total shunt rate 43%). In Group B (n = 34) treated with FMD without preoperative ICC estimation, five children (15%) required shunting due to complications. In Group A, we found a significantly higher frequency of headache, nausea, fatigue, and dizziness. The outcome assessed by the modified Chicago Chiari Outcome Scale (mean follow-up 83 ± 57 months) was comparable between the groups, but the complication rate after FMD was significantly lower in Group A (7% vs. 32%; p = 0.011). The number of procedures (ICP measurement, FMD, shunt, re-do FMD, shunt revisions) was significantly higher in Group A (2.6 ± 0.9 vs. 1.5 ± 1.1 per patient; p < 0.001).
CONCLUSIONS: In symptomatic children with CMI, the preoperative estimation of ICC from the overnight measurement of pulsatile ICP was more reliable for identifying those with reduced ICC than clinical and radiological assessment alone. When children with abnormally reduced ICC were identified and treated with CSF diversion before FMD, the complication rate was significantly reduced.
METHODS: We reviewed pediatric cases of CMI referred to FMD between 2006 and 2022. Children with clinical and/or radiological signs suggesting reduced ICC (Group A) underwent overnight measurements of the pulsatile intracranial pressure (ICP): mean ICP wave amplitude (MWA) served as a surrogate marker of ICC. Children with more typical symptoms of CMI (Group B) underwent FMD without preoperative ICC estimation. This study presents the clinical, radiological, and outcome differences between these groups.
RESULTS: Sixty-four children (mean age 11.1 ± 4.3 years) underwent FMD: In Group A (n = 30), the finding of reduced ICC as estimated from preoperative ICP measurement resulted in CSF diversion (ventriculoperitoneal shunt) before FMD in 11 children. Two patients required shunt due to complications after FMD (total shunt rate 43%). In Group B (n = 34) treated with FMD without preoperative ICC estimation, five children (15%) required shunting due to complications. In Group A, we found a significantly higher frequency of headache, nausea, fatigue, and dizziness. The outcome assessed by the modified Chicago Chiari Outcome Scale (mean follow-up 83 ± 57 months) was comparable between the groups, but the complication rate after FMD was significantly lower in Group A (7% vs. 32%; p = 0.011). The number of procedures (ICP measurement, FMD, shunt, re-do FMD, shunt revisions) was significantly higher in Group A (2.6 ± 0.9 vs. 1.5 ± 1.1 per patient; p < 0.001).
CONCLUSIONS: In symptomatic children with CMI, the preoperative estimation of ICC from the overnight measurement of pulsatile ICP was more reliable for identifying those with reduced ICC than clinical and radiological assessment alone. When children with abnormally reduced ICC were identified and treated with CSF diversion before FMD, the complication rate was significantly reduced.
摘要：
背景：在患有Chiari畸形1型（CMI）的成人中，证实了颅内顺应性（ICC）降低在大孔减压（FMD）后的结局中的作用。然而,缺少接受CMI治疗的儿童的类似观察结果.
方法：我们回顾了2006年至2022年间涉及FMD的CMI儿科病例。有临床和/或放射学体征提示ICC减少的儿童（A组）接受了脉动颅内压（ICP）的过夜测量：平均ICP波振幅（MWA）作为ICC的替代指标。有较典型CMI症状的儿童（B组）接受FMD，术前未行ICC评估。这项研究提出了临床，放射学,以及这些群体之间的结果差异。
结果：64名儿童（平均年龄11.1±4.3岁）接受口蹄疫治疗：A组（n=30），根据术前ICP测量估计的ICC减少的结果,导致11名儿童在FMD前发生CSF转流(脑室-腹腔分流术).两名患者由于FMD后的并发症而需要分流（总分流率43％）。B组(n=34)接受FMD治疗，术前未行ICC评估，五名儿童(15%)因并发症需要分流。A组,我们发现头痛的频率明显更高，恶心,疲劳,和头晕。通过改良的ChicagoChiari结局量表（平均随访83±57个月）评估的结果在两组之间具有可比性。但A组FMD术后并发症发生率明显较低(7%vs.32%；p=0.011）。程序的数量(ICP测量，口蹄疫,分流,重新做口蹄疫，分流修正)在A组中显著更高(2.6±0.9vs.每位患者1.5±1.1；p<0.001）。
结论：在有症状的CMI患儿中，与单纯的临床和放射学评估相比,通过通宵测量搏动性ICP对ICC进行术前评估更可靠.当发现ICC异常降低的儿童并在FMD之前接受CSF转流治疗时，并发症发生率明显降低。
方法：我们回顾了2006年至2022年间涉及FMD的CMI儿科病例。有临床和/或放射学体征提示ICC减少的儿童（A组）接受了脉动颅内压（ICP）的过夜测量：平均ICP波振幅（MWA）作为ICC的替代指标。有较典型CMI症状的儿童（B组）接受FMD，术前未行ICC评估。这项研究提出了临床，放射学,以及这些群体之间的结果差异。
结果：64名儿童（平均年龄11.1±4.3岁）接受口蹄疫治疗：A组（n=30），根据术前ICP测量估计的ICC减少的结果,导致11名儿童在FMD前发生CSF转流(脑室-腹腔分流术).两名患者由于FMD后的并发症而需要分流（总分流率43％）。B组(n=34)接受FMD治疗，术前未行ICC评估，五名儿童(15%)因并发症需要分流。A组,我们发现头痛的频率明显更高，恶心,疲劳,和头晕。通过改良的ChicagoChiari结局量表（平均随访83±57个月）评估的结果在两组之间具有可比性。但A组FMD术后并发症发生率明显较低(7%vs.32%；p=0.011）。程序的数量(ICP测量，口蹄疫,分流,重新做口蹄疫，分流修正)在A组中显著更高(2.6±0.9vs.每位患者1.5±1.1；p<0.001）。
结论：在有症状的CMI患儿中，与单纯的临床和放射学评估相比,通过通宵测量搏动性ICP对ICC进行术前评估更可靠.当发现ICC异常降低的儿童并在FMD之前接受CSF转流治疗时，并发症发生率明显降低。
