Clinical Efficacy Of Modified PFDD In Chiari Type Ⅰ Malformation With Syringomyelia

[Objective]To investigate the clinical efficacy of posterior fossa decompression with arachnoid integrity preserved and posterior fossa decompression with duraplast incision and dilatation(modified)and posterior fossa decompression without arachnoid integrity preserved and duraplast incision and dilatation(traditional)in the treatment of Chiari Ⅰmalformation complicated with syringomyelia.In order to provide reference for clinical.[Methods]A total of 43 patients diagnosed with Chiari type I malformation combined with syringomyelia and admitted to the Department of Neurosurgery,the First Affiliated Hospital of Dali University from January 2013 to December 2021 were selected,and their clinical data were retrospectively analyzed.The patients who underwent traditional posterior fossa decompression without retaining arachnoid integrity + duraplast incision and extended repair(group A)were selected as the control group,and the patients who underwent modified posterior fossa decompression with retaining arachnoid integrity +duraplast incision and extended repair(group B)were selected as the study group.There was no significant difference in gender,age and clinical symptoms before operation.The operation time,intraoperative blood loss,improvement of clinical symptoms and changes in imaging at different periods after operation were compared between the two groups.After the complete data were collected,the corresponding statistical analysis was performed by SPSS28.0 to explore the clinical efficacy,advantages and disadvantages of the two surgical methods in the treatment of Chiari type I malformation with syringomyelia.[Results]A total of 43 patients were included in the study.Among them,11 patients underwent traditional posterior fossa decompression and duraplast incision and extended repair(traditional operation)as the control group(group A),and 32 patients underwent modified posterior fossa decompression and extended repair(modified operation)as the study group(group B).The average length of hospital stay was 23±10.94 days in group A and19.03±6.33 days in group B,and the difference was not statistically significant(P>0.05).There was no significant difference in the operation time and intraoperative blood loss between the two groups(P>0.05).At 3 months and 1 year after surgery,the improvement of clinical symptoms in group A was 5 cases(45.45%)and 9 cases(81.82%),and in group B was 28 cases(87.50%)and 32 cases(100.00%),and the difference was not statistically significant(P>0.05).Chicago Chiari Outcome Scale(CCOS)scores at 3 months and 1year after surgery in group A were 14.00(13.00,15.00)and 16.00(16.00,16.00),respectively.The score of group B was 14.00(13.00,14.00)points and 16.00(15.25,16.00)points,and the difference was not statistically significant(P>0.05).At 3 months and 1year after surgery,the proportion of cerebellar tonsil rebound in group A was54.91(43.51,60.98)% and 88.03(83.21,100.00)%,respectively.The proportion of cerebellar tonsil rebound in group B was 58.90(52.79,62.55)% and 87.60(81.76,94.51)%,respectively,and the difference was not statistically significant(P>0.05).At 3 months and1 year after surgery,the proportion of syringomyelia reduction in group A was69.22(57.45,74.35)% and 98.79(96.49,100.00)%,respectively.The proportion of syringomyelia reduction in group B was 61.61(54.79,74.56)% and 97.43(95.51,100.00)%,respectively,and the difference was not statistically significant(p>0.05).In terms of postoperative complications,4 patients(39.60%)had subcutaneous effusion and 1 patient(9.09%)had cerebrospinal fluid leakage in group A.In group B,1 patient had subcutaneous effusion(3.13%)and 1 patient had intracranial infection(3.13%).All patients with subcutaneous hydrops in the two groups recovered smoothly after extracting hydrops,strengthening dressing and pressure dressing in the operation area.The difference between the two groups was statistically significant(p<0.05).[Conclusion]Posterior fossa decompression without arachnoidal integrity and duraplast expansion repair(traditional operation)and posterior fossa decompression with arachnoidal integrity and duraplast expansion repair(modified operation)are both safe and effective for the treatment of Chiari malformation with syringomyelia,and there is no statistically significant difference in postoperative efficacy.However,in terms of reducing postoperative complications,posterior fossa decompression and duraplast expansion repair with preservation of arachnoid integrity(modified operation)has more advantages.