Influence of posterior cranial fossa decompression combined with various dural management techniques on the prognosis of Chiari malformation type Ⅰ

doi:10.3877/cma.j.issn.2095-9141.2024.04.003

Abstract

Abstract:

Objective

To compare the short-term efficacy, postoperative complications, operative time, and long-term outcomes of using different materials of artificial dura for duraplasty or outer dural layer incision after posterior fossa decompression in patients with Chiari malformation type Ⅰ(CM-Ⅰ).

Methods

A retrospective analysis was performed on the clinical data of 169 patients with CM-I treated at Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University from September 2012 to December 2023.Among them,30 patients underwent posterior fossa decompression+outer dural layer incision (group A), and 139 patients underwent posterior fossa decompression + duraplasty (group B), including 61 patients using collagen-based biological dura (group B1); 59 patients using polyester urethane fiber synthetic dura (group B2);and 19 patients using artificial dura composed of Polyglactin910 sutures and Polydioxanone (PDO) sutures (group B3). The postoperative short - term Tator scores,complications,surgical time,and long-term prognosis of four groups were compared.

Results

There was no statistically significant difference in the short-term efficacy, improvement rate, and complication rates between group A and groups B1, B2, and B3 (P＞0.05). The median surgical time of group A was shorter than that of groups B1, B2, and B3, and the differences were statistically significant (P＜0.05). The evaluation results of CCOS score and Tator score showed that the improvement rate and progression rate of group A were higher than those of groups B1, B2, and B3, and the differences were statistically significant (P＜0.05);there was no statistically significant differences among the B1,B2,and B3 groups(P＞0.05).

Conclusion

In CM-I patients,dural outer layer incision following posterior fossa decompression has a relatively shorter surgical time and better long-term outcomes compared to expanded duraplasty with different dural materials.

Key words: Chiari malformation type Ⅰ, Circumoccipital decompression, Epidural incision surgery, Epidural enlargement surgery, Artificial dura mater

Lili Li, Xin Chen, Shiguang Zhao, He Yang. Influence of posterior cranial fossa decompression combined with various dural management techniques on the prognosis of Chiari malformation type Ⅰ[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(04): 206-212.

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References 16

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组别	例数	年龄[岁，M（P₂₅，P₇₅）]	病程[个月，M（P₂₅，P₇₅）]	性别（男/女）	头痛、头晕	颈背部疼痛、麻木	肌肉萎缩	肢体麻木、疼痛	感觉、运动或步态异常	痛温觉障碍
A组	30	49.5（43.0，54.0）	12.0（4.0，48.0）	7/23	11	15	3	25	20	10
B1组	61	49.0（42.0，54.0）	12.0（3.0，36.0）	15/46	27	30	11	51	40	20
B2组	59	48.0（37.0，53.0）	12.0（3.0，45.0）	16/43	35	27	4	49	39	22
B3组	19	49.0（39.0，59.0）	36.0（6.0，96.0）	2/17	11	10	3	17	17	7
H/χ²值		1.423	3.206	2.235	5.455	0.345	3.851	0.481	3.300	0.332
P值		0.700	0.360	0.525	0.141	0.951	0.264	0.959	0.348	0.954

组别	例数	年龄[岁，M（P₂₅，P₇₅）]	病程[个月，M（P₂₅，P₇₅）]	性别（男/女）	头痛、头晕	颈背部疼痛、麻木	肌肉萎缩	肢体麻木、疼痛	感觉、运动或步态异常	痛温觉障碍
A组	30	49.5（43.0，54.0）	12.0（4.0，48.0）	7/23	11	15	3	25	20	10
B1组	61	49.0（42.0，54.0）	12.0（3.0，36.0）	15/46	27	30	11	51	40	20
B2组	59	48.0（37.0，53.0）	12.0（3.0，45.0）	16/43	35	27	4	49	39	22
B3组	19	49.0（39.0，59.0）	36.0（6.0，96.0）	2/17	11	10	3	17	17	7
H/χ²值		1.423	3.206	2.235	5.455	0.345	3.851	0.481	3.300	0.332
P值		0.700	0.360	0.525	0.141	0.951	0.264	0.959	0.348	0.954

组别	例数	优	良	差	有效率[例（%）]	好转率[例（%）]
A组	30	22	8	0	30（100.0）	22（73.3）
B1组	61	36	23	2	59（96.7）	36（59.0）
B2组	59	41	16	2	57（96.6）	41（69.5）
B3组	19	13	5	1	18（94.7）	13（68.4）
H/χ²值		2.423			3.000	1.326
P值		0.489			0.392	0.723

组别	例数	优	良	差	有效率[例（%）]	好转率[例（%）]
A组	30	22	8	0	30（100.0）	22（73.3）
B1组	61	36	23	2	59（96.7）	36（59.0）
B2组	59	41	16	2	57（96.6）	41（69.5）
B3组	19	13	5	1	18（94.7）	13（68.4）
H/χ²值		2.423			3.000	1.326
P值		0.489			0.392	0.723

组别	例数	发热	头痛	颅内感染	切口裂开	静脉血栓形成	发生率[例（%）]
A组	30	1	0	0	1	1	3（10.0）
B1组	61	9	4	3	0	0	16（26.2）
B2组	59	8	11	2	1	0	22（37.2）
B3组	19	2	4	1	0	0	7（36.8）
χ ²值							27.687
P值							0.112

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