背景:ChiariI畸形,以严重的头痛和潜在的脑干/脊髓问题为标志,当保守方法失败时,通常需要手术干预。这项研究介绍了一种利用3叶片牵开器的微创手术(MIS)Chiari减压技术,旨在减少术后不适并优化结果。
方法:包括接受MIS技术的Chiari1型畸形患者。技术包括使用三叶片牵开器的最小软组织开口,枕下骨瓣切除术,C1椎板切除术,并切除无硬骨切开术的寰枕带。
结果:10例患者接受治疗。平均年龄为43.3岁,其中7名女性。所有患者都出现枕骨头痛,50%眶后疼痛,40%颈部,上背部或肩部疼痛,和30%的肢体感觉异常。术前改良Rankin量表(mRS)中位数为3(2-4),疼痛视觉模拟评分(VAS)为7(5-9)。平均手术时间为59(59-71)分钟,平均失血量为88.5(50-140)mL。90%的患者在同一手术日出院(术后平均7.2[5.3-7.7]小时)。没有证据表明术后立即或延迟的并发症。6个月时,90%的患者有mRS0-1。末次随访时VAS平均值为1.5(范围0-4,p<0.001)。
结论:MIS3刀式柔性牵开器技术用于Chiari减压是可行的,提供枕下区域和C1弓的宽可视化角度,允许两名外科医生工作,并最大限度地减少皮肤和软组织的破坏。这种组合可以减少术后的不适,降低手术部位感染的风险,优化结果。
BACKGROUND: Chiari I malformation, marked by severe headaches and potential brainstem/spinal cord issues, often requires surgical intervention when conservative methods fail. This study introduces a minimally invasive surgery (MIS) Chiari decompression technique utilizing a 3-blade retractor, aiming to reduce postoperative discomfort and optimize outcomes.
METHODS: Chiari type I malformation patients who underwent a MIS technique were included. Technique consisted of a minimal-soft tissue opening using a 3-blade retractor, suboccipital craniectomy, C1 laminectomy, and resection of the atlantooccipital band without a durotomy.
RESULTS: Ten patients were treated. Mean age was 43.3 years, with 7 female patients. All patients presented with occipital headaches; 50% retroorbital pain; 40% neck, upper back, or shoulder pain; and 30% limb paresthesias. Median pre-surgical modified Rankin Scale (mRS) was 3 (2-4) and pain visual analog score (VAS) was 7 (5-9). Mean operative time was 59 (59-71) minutes, with mean blood loss of 88.5 (50-140) mL. In our sample, 90% of patients were discharged the same surgical day (mean 7.2 [5.3-7.7] hours postoperative). No immediate or delayed postoperative complications were evidenced. At 6 months, 90% of patients had mRS 0-1. At last follow-up the mean VAS was 1.5 (range: 0-4, P < 0.001).
CONCLUSIONS: The MIS 3-blade flexible retractor technique for Chiari decompression is feasible, provides wide visualization angles of the suboccipital region and C1 arch, allows 2-surgeon work, and minimizes skin and soft tissue disruption. This combination may diminish postoperative discomfort, reduce the risk of surgical site infections, and optimize outcomes.