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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Kamlesh Rangari (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Kuntal Kanti Das (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Suyash Singh (All India Institute of Medical Sciences) Krishna G. Kumar (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Kamlesh Singh Bhaisora (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Jayesh Sardhara (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Anant Mehrotra (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Arun Kumar Srivastava (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Awadhesh Kumar Jaiswal (Department of Neurosurgery Sanjay Gandhi Post Graduate Institute of Medical Sciences) Sanjay Behari (Department of Neurosurgery Sanjay Gandhi Postgraduate Institute of Medical Sciences)
저널정보
대한척추신경외과학회 Neurospine 대한척추신경외과학회지 제18권 제1호
발행연도
2021.1
수록면
126 - 138 (13page)

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Objective: Posterior fossa decompression is the treatment of choice in type 1 Chiari malformation (CM-1) without bony instability. Although surgical fixation has been recommended by a few authors recently, comparative studies to evaluate these treatment strategies using objective outcome tools are lacking. Methods: Seventy-three patients with pure CM-1 (posterior fossa bony decompression [PFBD], n=21; posterior fossa bony and dural decompression [PFBDD], n=40; and posterior fixation [PF], n=12) underwent a postoperative outcome assessment using Chicago Chiari Outcome Score (CCOS). Logistic regression analysis detected predictors of an unfavorable outcome. Results: Minimally symptomatic patients generally underwent a PFBD while most of the clinically severe patients underwent a PFBDD (p=0.049). The mean CCOS score at discharge was highest in the PF (12.0±1.41) and lowest in PFBDD group (10.98±1.73, p=0.087). Patients with minimal preoperative clinical disease severity (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.29–16.31) and PFBDD (AOR, 7.56; 95% CI, 1.70–33.68) represented risks for an unfavorable short-term postoperative outcome. Though long-term outcomes (CCOS) did not differ among the 3 groups (p=0.615), PFBD group showed the best long-term improvements (mean follow-up CCOS, 13.71±0.95), PFBDD group improved to a comparable degree despite a poorer short-term outcome while PF had the lowest scores. Late deteriorations (n=3, 4.1%) occurred in the PFBDD group. Conclusion: Minimally symptomatic patients and PFBDD predict a poor short-term postoperative outcome. PFBD appears to be a durable procedure while PFBDD group is marred by complications and late deteriorations. PF does not provide any better results than posterior fossa decompression alone in the long run.
#Chiari malformation #Posterior fossa decompression #Syrinx #Posterior fixation #Predictors #Functional outcome

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참고문헌 (42)

참고문헌 신청
Shah AH / 2017 / Chiari malformation: has the dilemma ended? / J Craniovertebr Junction Spine 8:297~304 google schola Dean Chou / 2019 / How Should We Consider New Theories of Chiari Malformation Pathogenesis? / Neurospine 16(2):219~220 dbpia Nash J / 2002 / Chiari type I malformation: overview of diagnosis and treatment / WMJ 101:35~40 google schola ishikawa M / 1997 / Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa / J Neurosurg 86:40~47 google schola Goel A / 2015 / Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation / J Neurosurg Spine 22:116~127 google schola

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