PDF(Pubmed)
Abstract：
BACKGROUND: A subset of children with Chiari 1 malformation (CM-1) have a 4th ventricle arachnoid veil-a thin membrane covering the outlet of the 4th ventricle. Studies suggest that failure to disrupt this veil during posterior fossa decompression can reduce the likelihood of syringomyelia resolution. However, there is no reliable method for predicting the presence of the veil without direct surgical exploration. This study aims to evaluate the association between pre-operative symptoms, radiographic measurements, and the arachnoid veil.
METHODS: A retrospective review of an institutional database of children evaluated for CM-I was conducted. For patients treated with surgery, operative notes were reviewed to determine if an arachnoid veil was present. Logistic regression was used to test for relationship of clinical variables and radiographic measurements with the presence of an arachnoid veil.
RESULTS: Out of 997 children with CM-1, 226 surgical patients were included in the analysis after excluding those with inadequate documentation. An arachnoid veil was found in 23 patients (10.2%). Larger syrinx, spinal canal, and thecal sac diameters were significantly associated with the presence of a veil, with odds ratios of 1.23 (95% CI 1.2-1.48; p = 0.03), 1.27 (95% CI 1.02-1.59; p = 0.03), and 1.35 (95% CI 1.03-1.77; p = 0.03), respectively. No significant associations were found with any signs or symptoms.
CONCLUSIONS: Arachnoid veil was present in 10% of cases. Radiographic measurements indicating larger syrinx size were the only variables found to be significantly associated with an arachnoid veil. Exploration of the 4th ventricular outlet is recommended for CM-I decompression in the setting of expansile syringomyelia.
METHODS: A retrospective review of an institutional database of children evaluated for CM-I was conducted. For patients treated with surgery, operative notes were reviewed to determine if an arachnoid veil was present. Logistic regression was used to test for relationship of clinical variables and radiographic measurements with the presence of an arachnoid veil.
RESULTS: Out of 997 children with CM-1, 226 surgical patients were included in the analysis after excluding those with inadequate documentation. An arachnoid veil was found in 23 patients (10.2%). Larger syrinx, spinal canal, and thecal sac diameters were significantly associated with the presence of a veil, with odds ratios of 1.23 (95% CI 1.2-1.48; p = 0.03), 1.27 (95% CI 1.02-1.59; p = 0.03), and 1.35 (95% CI 1.03-1.77; p = 0.03), respectively. No significant associations were found with any signs or symptoms.
CONCLUSIONS: Arachnoid veil was present in 10% of cases. Radiographic measurements indicating larger syrinx size were the only variables found to be significantly associated with an arachnoid veil. Exploration of the 4th ventricular outlet is recommended for CM-I decompression in the setting of expansile syringomyelia.
摘要：
背景：Chiari1畸形（CM-1）的儿童子集具有第四脑室蛛网膜-覆盖第四脑室出口的薄膜。研究表明，后颅窝减压过程中无法破坏这种面纱可以降低脊髓空洞症消退的可能性。然而,没有可靠的方法来预测面纱的存在没有直接的手术探查。这项研究旨在评估术前症状之间的关联，射线照相测量，和蛛网膜的面纱.
方法：对一个被评估为CM-I的儿童的机构数据库进行回顾性审查。对于接受手术治疗的患者，检查手术记录以确定是否存在蛛网膜面纱。Logistic回归用于测试临床变量和影像学测量与蛛网膜存在的关系。
结果：在997例CM-1患儿中，226例手术患者在排除文献不足的患者后被纳入分析。在23例患者（10.2％）中发现了蛛网膜。更大的注射器，椎管,鞘囊直径与面纱的存在显着相关，比值比为1.23(95%CI1.2-1.48；p=0.03)，1.27（95%CI1.02-1.59；p=0.03），和1.35（95%CI1.03-1.77；p=0.03），分别。没有发现与任何体征或症状的显著关联。
结论：10%的病例存在蛛网膜面纱。射线照相测量表明较大的syrinx大小是唯一发现与蛛网膜面纱显着相关的变量。在扩张性脊髓空洞症的情况下，建议对第4个心室出口进行CM-I减压。
方法：对一个被评估为CM-I的儿童的机构数据库进行回顾性审查。对于接受手术治疗的患者，检查手术记录以确定是否存在蛛网膜面纱。Logistic回归用于测试临床变量和影像学测量与蛛网膜存在的关系。
结果：在997例CM-1患儿中，226例手术患者在排除文献不足的患者后被纳入分析。在23例患者（10.2％）中发现了蛛网膜。更大的注射器，椎管,鞘囊直径与面纱的存在显着相关，比值比为1.23(95%CI1.2-1.48；p=0.03)，1.27（95%CI1.02-1.59；p=0.03），和1.35（95%CI1.03-1.77；p=0.03），分别。没有发现与任何体征或症状的显著关联。
结论：10%的病例存在蛛网膜面纱。射线照相测量表明较大的syrinx大小是唯一发现与蛛网膜面纱显着相关的变量。在扩张性脊髓空洞症的情况下，建议对第4个心室出口进行CM-I减压。
