基于人群的队列研究：1 型奇异畸形儿科患者后窝减压术后的长期疗效。

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2024-11-18 DOI:10.1007/s00701-024-06332-3

Victor Gabriel El-Hajj, Erik Öhlén, Ulrika Sandvik, Jenny Pettersson-Segerlind, Elias Atallah, Pascal Jabbour, Mohamad Bydon, David J. Daniels, Adrian Elmi-Terander, Erik Edström

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引用次数: 0

摘要

目的：后窝减压术治疗 Chiari 畸形 I 型（Chiari 1）效果显著，并发症风险较低。然而，多达 20% 的患者在手术治疗后可能会继续出现功能障碍或症状复发。对于儿科患者，目前还没有成熟的工具来预测预后，而且对术后不良预后的风险因素也知之甚少。因此，我们的目的是调查基线数据和术后早期不良后果的预测因素，这些因素由芝加哥Chiari结局量表（CCOS）决定：方法：所有儿科患者（结果：71 名儿科患者，平均年龄为 12 岁）均接受了手术：结果：共纳入 71 名儿童患者，中位年龄为 9 岁。大多数患者（58%）为女性。Chiari 1伴有鞘膜积液（51%）、脊柱侧弯（37%）和脑积水（7%）。13名患者（18%）出现了围手术期并发症，其中两名患者需要在全身麻醉下进行额外的手术。在多变量比例赔率逻辑回归中，运动障碍（OR：0.09；CI95%：[0.01-0.62]；P = 0.015）和手术并发症（OR：0.16；CI95%：[0.41-0.66]；P = 0.011）是预示不良预后的重要因素。存在鞘膜积液被认为是较好预后的预测因素（OR：4.42 CI95% [1.02-19.35]；P = 0.048）。后窝减压术后早期持续性脑积水是长期CCOS恶化的有力预测因素（OR：0.026；CI95%：[0.002-0.328]；P = 0.005）：本研究结果表明，手术前存在运动障碍和鞘膜积液、手术并发症和后窝减压术后持续脑积水是预测长期预后的有效指标。

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Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study

Objective

Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS).

Methods

All pediatric patients (< 18 years) receiving a posterior fossa decompression for Chiari 1 between the years of 2005 and 2020 at the study center were eligible for inclusion. Patients with congenital anomalies were excluded.

Results

Seventy-one pediatric patients with a median age of 9 years were included. Most patients (58%) were females. Chiari 1 was associated with syringomyelia (51%), scoliosis (37%), and hydrocephalus (7%). Perioperative complications occurred in 13 patients (18%) of which two required additional procedures under general anesthesia. On multivariable proportional odds logistic regression, motor deficits (OR: 0.09; CI95%: [0.01–0.62]; p = 0.015), and surgical complications (OR: 0.16; CI95%: [0.41–0.66]; p = 0.011) were significant predictors of worse outcomes. The presence of syringomyelia was identified as a predictor of better outcomes (OR: 4.42 CI95% [1.02–19.35]; p = 0.048). A persistent hydrocephalus during the early postoperative period after posterior fossa decompression was a strong predictor of worse long-term CCOS (OR: 0.026; CI95%: [0.002–0.328]; p = 0.005).

Conclusion

Results from this study indicate that the existence of motor deficits and syringomyelia prior to surgery, and surgical complications and persistent hydrocephalus despite posterior fossa decompression, were useful predictors of long-term outcome.

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.