Different Surgical Treatments Of Chiari Malformation Type Ⅰ With Syringomyelia And Effects Comparison

Objective:To explore the effects and several surgical treatments of Chiari malformation type I with syringomyelia.Methods:The clinical data from July 2009 to January 2020 came from the Neurosurgery Apartment in in The Second Affiliated Hospital of Soochow University,The First Affiliated Hospital of Soochow University and Suzhou Kowloon Hospital.Seventy-nine cases of Chiari malformation type Ⅰ with syringomyelia which accepted surgical treatments were analyzed retrospectively.Six cases complicated with basilar invagination were divided into group Ⅰ,the remained cases were classified according to the surgical methods.Group ⅡA including 9 cases underwent posterior fossa decompression;group ⅡB including 26 cases underwent posterior fossa decompression plus cisterna magna reconstruction;group ⅡC including 38 cases underwent posterior fossa decompression plus cerebellar tonsil resection.We evaluated the patients’ age,sex,postoperative clinical and imaging improvement,complications,etc.According to the artificial dura used during the operation,64 dural opening cases were divided into artificial dural group(43 cases)and autologous group(21 cases).The operative time,intraoperative blood loss,secondary operation,secondary hospitalization and complications between the two groups were compared.Results:According to the clinical efficacy and imaging improvement,there was no statistical difference between group Ⅰ and the other groups(p>0.05),but the tonsil retraction and cavity improvement was significantly worse than group ⅡB and group ⅡC(p<0.05).There was no significant difference between group ⅡA and the other groups in short-term and long-term efficacy(p>0.05).There was no statistical difference between group ⅡB and group ⅡC in short-term curative effect,long-term curative effect and imaging improvement(p>0.05).There was no significant difference in complications from group ⅡA,ⅡB and ⅡC(p>0.05).According to the operative time and intraoperative blood loss,group ⅡA was significantly lower than those in group ⅡB(p<0.05)and groupⅡ C(p<0.05),while there was no significant difference between group ⅡB and group ⅡC(p>0.05).There was no significant difference in intraoperative blood loss and operation time between the artificial dura group and the autologous group(p>0.05).The reoperation rate and hospitalization rate of the artificial dura group were significantly higher than those in the autologous group.The incidence of postoperative complications in the autologous group was significantly lower than that in the artificial dura group(p<0.05).Conclusions:Chiari malformation type Ⅰ complicated with syringomyelia patients should be evaluated for the stability of craniocervical junction before surgery.For unstable patients,they must be reduced and fixed.Posterior craniocervical reduction and fixation can obtain well-pleasing surgical results.For stable patients,decompression should be carried out according to the compression position.The operative time and intraoperative blood loss in the posterior fossa bony decompression group are lower than those in the occipital cistern reconstruction group and tonsillectomy group,but the tonsillectomy retraction and cavity improvement are worse than those in the occipital cistern reconstruction group and tonsillectomy group.There is no statistical difference between the occipital cistern reconstruction group and tonsillectomy group,and the choice of specific surgical methods still needs further research and discussion.The use of artificial dura may increase secondary hospitalization and reoperation,and the incidence of postoperative complications in the artificial dura group is significantly higher than that in the autologous group.