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Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study.
Neurosurg Focus. 2023 03; 54(3):E4.NF

Abstract

OBJECTIVE

The purpose of this study was to compare the prognosis of patients with Chiari malformation type I (CM-I) treated with posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression with resection of tonsils (PFDRT).

METHODS

The clinical data of patients with CM-I treated using these two procedures in three medical centers between January 2016 and June 2021 were retrospectively analyzed and divided into PFDD and PFDRT groups according to the procedures. The Chicago Chiari Outcome Scale (CCOS) was used to score the patients and compare the prognosis of the two groups.

RESULTS

A total of 125 patients with CM-I were included, of whom 90 (72.0%) were in the PFDD group, and 35 (28.0%) were in the PFDRT group. There was no significant difference in the overall essential characteristics of the two groups. Moreover, there was no significant difference in complication rates (3.3% vs 8.6%, p = 0.348), CCOS scores (13.5 ± 1.59 vs 14.0 ± 1.21, p = 0.111), and the probability of poor prognosis (25.6% vs 11.4%, p = 0.096) between the two groups. Nevertheless, a subgroup of patients who had CM-I combined with syringomyelia (SM) revealed higher CCOS scores (13.91 ± 1.12 vs 12.70 ± 1.64, p = 0.002) and a lower probability of poor prognosis (13.0% vs 40.4%, p = 0.028) in the PFDRT than in the PFDD group. Also, SM relief was more significant in patients in the PFDRT compared to the PFDD group. A logistic multifactor regression analysis of poor prognosis in patients with CM-I and SM showed that the PFDRT surgical approach was a protective factor compared to PFDD. Furthermore, by CCOS analysis, it was found that the main advantage of PFDRT in treating patients with CM-I and SM was to improve patients' nonpain and functionality scores.

CONCLUSIONS

Compared with PFDD, PFDRT is associated with a better prognosis for patients with CM-I and SM and is a protective factor for poor prognosis. Therefore, the authors suggest that PFDRT may be considered for patients with CM-I and SM.

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Publisher Full Text (DOI)

Authors+Show Affiliations

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

2Department of Neurosurgery, Taihe Hospital, Jinzhou Medical University Union Training Base, Shiyan, Hu Bei. 3Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hu Bei; and.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei. 4Department of Neurosurgery, Wuhan Union Hospital, Wuhan, Hu Bei, China.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

4Department of Neurosurgery, Wuhan Union Hospital, Wuhan, Hu Bei, China.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

3Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hu Bei; and.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hu Bei.

MeSH

HumansArnold-Chiari MalformationTonsillectomyRetrospective StudiesPrognosisDecompression

Pub Type(s)

Multicenter Study

Journal Article

Language

eng

PubMed ID

36857790

Citation

Cai, Yuankun, et al. "Prognostic Analysis of Posterior Fossa Decompression With or Without Cerebellar Tonsillectomy for Chiari Malformation Type I: a Multicenter Retrospective Study." Neurosurgical Focus, vol. 54, no. 3, 2023, pp. E4.

Cai Y, Wang C, Chai S, et al. Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study. Neurosurg Focus. 2023;54(3):E4.

Cai, Y., Wang, C., Chai, S., Li, G., Zhang, T., Liu, Z., Yi, D., Chen, J., Hu, J., Liu, K., & Xiong, N. (2023). Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study. Neurosurgical Focus, 54(3), E4. https://doi.org/10.3171/2022.12.FOCUS22626

Cai Y, et al. Prognostic Analysis of Posterior Fossa Decompression With or Without Cerebellar Tonsillectomy for Chiari Malformation Type I: a Multicenter Retrospective Study. Neurosurg Focus. 2023;54(3):E4. PubMed PMID: 36857790.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study. AU - Cai,Yuankun, AU - Wang,Chaobin, AU - Chai,Songshan, AU - Li,Guo, AU - Zhang,Tingbao, AU - Liu,Zheng, AU - Yi,Dongye, AU - Chen,Jincao, AU - Hu,Juntao, AU - Liu,Kui, AU - Xiong,Nanxiang, PY - 2022/09/13/received PY - 2022/12/15/accepted PY - 2023/3/1/entrez PY - 2023/3/2/pubmed PY - 2023/3/4/medline KW - Chiari malformation type I KW - cerebellar tonsillectomy KW - posterior fossa decompression KW - prognosis KW - syringomyelia SP - E4 EP - E4 JF - Neurosurgical focus JO - Neurosurg Focus VL - 54 IS - 3 N2 - OBJECTIVE: The purpose of this study was to compare the prognosis of patients with Chiari malformation type I (CM-I) treated with posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression with resection of tonsils (PFDRT). METHODS: The clinical data of patients with CM-I treated using these two procedures in three medical centers between January 2016 and June 2021 were retrospectively analyzed and divided into PFDD and PFDRT groups according to the procedures. The Chicago Chiari Outcome Scale (CCOS) was used to score the patients and compare the prognosis of the two groups. RESULTS: A total of 125 patients with CM-I were included, of whom 90 (72.0%) were in the PFDD group, and 35 (28.0%) were in the PFDRT group. There was no significant difference in the overall essential characteristics of the two groups. Moreover, there was no significant difference in complication rates (3.3% vs 8.6%, p = 0.348), CCOS scores (13.5 ± 1.59 vs 14.0 ± 1.21, p = 0.111), and the probability of poor prognosis (25.6% vs 11.4%, p = 0.096) between the two groups. Nevertheless, a subgroup of patients who had CM-I combined with syringomyelia (SM) revealed higher CCOS scores (13.91 ± 1.12 vs 12.70 ± 1.64, p = 0.002) and a lower probability of poor prognosis (13.0% vs 40.4%, p = 0.028) in the PFDRT than in the PFDD group. Also, SM relief was more significant in patients in the PFDRT compared to the PFDD group. A logistic multifactor regression analysis of poor prognosis in patients with CM-I and SM showed that the PFDRT surgical approach was a protective factor compared to PFDD. Furthermore, by CCOS analysis, it was found that the main advantage of PFDRT in treating patients with CM-I and SM was to improve patients' nonpain and functionality scores. CONCLUSIONS: Compared with PFDD, PFDRT is associated with a better prognosis for patients with CM-I and SM and is a protective factor for poor prognosis. Therefore, the authors suggest that PFDRT may be considered for patients with CM-I and SM. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/36857790/Prognostic_analysis_of_posterior_fossa_decompression_with_or_without_cerebellar_tonsillectomy_for_Chiari_malformation_type_I:_a_multicenter_retrospective_study_ DB - PRIME DP - Unbound Medicine ER -