Objective:To identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1.Method:Patients who were clinically suspected to have Chiari malformation...Objective:To identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1.Method:Patients who were clinically suspected to have Chiari malformation type 1 and were referred to the Department of Radiology between 2007 and 2020,and whose diagnosis was radiologically confirmed through magnetic resonance imaging(MRI),were retrospectively evaluated.A total of 49 Chiari malformation type 1 patients with both cervical and cerebral examinations and 49 control subjects of the same age and gender without a diagnosis of Chiari malformation type 1 were included in the study.In Chiari malformation type 1 diagnosed patients,the presence of pseudotumor cerebri,the presence of syringomyelia in cervical spinal MRI images,and the distance of cerebellar tonsils and obex according to McRae line were evaluated in millimeters.Result:In Chiari malformation type 1 clinically and radiologically diagnosed cases,the cerebellar tonsils and obex were located lower in patients with a radiological diagnosis of pseudotumor cerebri compared to those without,and the rate of accompanying syringomyelia appeared to be higher.However,no statistically significant difference was observed between the two groups.Conclusion:The coexistence of pseudotumor cerebri and Chiari malformation type 1 is more common than previously estimated.Different treatment protocols in the coexistence of pseudotumor cerebri and Chiari malformation type 1 emphasize the importance of making this diagnosis.Further radiological imaging studies are needed to identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1.展开更多
A growing number of children and adolescents are being diagnosed as Chiari malformation type I （CM- I ） for behavioral disorders, developmental delay, seizures, or abnormal orpharyngeal function. The aim of this stu...A growing number of children and adolescents are being diagnosed as Chiari malformation type I （CM- I ） for behavioral disorders, developmental delay, seizures, or abnormal orpharyngeal function. The aim of this study was to compare the clinical characteristics, imaging findings and surgical outcomes of CM- I in pediatric and adult patients. Between January 2014 and June 2017, 84 patients with CM- I underwent surgical treatment in our department. We divided the patients into two groups： pediatric group （n=l 1, age 〈18 years） and adult group （n=73, age 〉18 years）. Data on clinical characteristics, imaging findings, surgical outcomes, and prognosis were retrospectively reviewed and compared between these two groups. For clinical presentation, scoliosis （36.4%） and developmental delay （36.4%） were more common in pediatric patients, whereas, sensory disturbance （58.9%） and motor weakness （41. 1%） were more common in adult patients. Imaging findings showed that the incidence of hydrocephalus and craniovertebral junctional abnormalities was significantly higher in pediatric group than in adult group （P〈0.05）. Compared to adult group, pediatric group showed a better improvement or resolution of syrinx and tonsillar herniation after surgical treatments （P〈0.05）. The total Chicago Chiari Outcome Scale （CCOS） score in pediatric patients at the last follow- up was significantly higher than that in adult patients （P=0.002）. In conclusion, the clinical characteristics and imaging findings appeared to be different in pediatric and adult patients with CM- I. The surgical outcomes of pediatric patients were shown to be significantly better than those of adult patients.展开更多
<strong>Aim of the work:</strong> This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological ...<strong>Aim of the work:</strong> This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological follow up in adults.<strong> Patients and methods: </strong>This study included 30 consecutive patients with Chiari malformation type I who were indicated for surgery at neurosurgery department. Data were collected prospectively from the involved patients who were evaluated preoperatively and underwent evaluation by CT scanning of the brain & skull and MRI imaging of the brain and spine. CT and MRI were done as the routine follow up investigations for all patients. We operated through midline suboccipital craniectomy, durotomy in y shaped manner, shrinkage of cerebellar tonsils by bipolar electrocautery, duroplasty by fascia lata graft, watertight closure. <strong>Results: </strong>The assessment from E. J. N. S. (Egyptian Journal of Neurosurgery) vol. 24 no. 2 June 2009 used for evaluating the patients clinically. 18 patients reported good outcome, 6 fair, 6 poor. We evaluated the size of the syrinx if present preoperative in follow up. 15 (50%) patients showed marked reduction (more than or equal to 60%) in size of syrinx, 3 (10%) mild reduction (less than or equal to 30%) in size and 12 (40%) with no change. <strong>Conclusion:</strong> The Chiari type 1 malformation constitutes a controllable malformation with good outcomes. With current microsurgical techniques, the results of the bony decompression and duroplasty became excellent. Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications.展开更多
目的：探讨成人Chiari畸形Ⅰ型（Chiari malformation type Ⅰ，CMⅠ）患者后颅窝线性容积特征及其与脊髓空洞和小脑扁桃体下疝程度之间的相关性。方法：收集2010年6月~2014年6月在我院接受治疗的CMⅠ患者，入选标准为：（1）年龄＞30...目的：探讨成人Chiari畸形Ⅰ型（Chiari malformation type Ⅰ，CMⅠ）患者后颅窝线性容积特征及其与脊髓空洞和小脑扁桃体下疝程度之间的相关性。方法：收集2010年6月~2014年6月在我院接受治疗的CMⅠ患者，入选标准为：（1）年龄＞30岁；（2）经头颈部MRI确诊为CMⅠ伴或不伴脊髓空洞；所有入选患者均排除颅内占位性病变、颅骨破坏、后颅窝手术史或获得性Chiari畸形。选取年龄匹配的正常成人作为对照组，测量两组头颅正中矢状位MRI中斜坡长度、枕骨大孔横径、枕上长度、后颅窝矢状径、后颅窝高径和后颅窝斜坡倾斜角α等指标，并将两组按性别分组后比较后颅窝线性容积差异。同时根据小脑扁桃体下疝程度及是否伴发脊髓空洞进行分组，分析后颅窝线性容积特征与小脑扁桃体下疝程度及脊髓空洞的关系。结果：共纳入CMⅠ患者37例，男18例，女19例；年龄38.5±5.5岁（31～56岁）。正常对照组41例，男19例，女22例；年龄36.4±6.3岁（33～58岁），成人CMⅠ患者后颅窝斜坡长度、枕上长度、后颅窝矢状径、后颅窝高径及斜坡倾斜角分别为35.9±4.2mm、38.2±5.8mm、77.4±6.1mm、28.2±3.9mm和47.4°±6.4°，均明显小于正常对照组（43.3±2.9mm、43.5±5.6mm、82.5±4.5mm、35.4±3.4mm、58.6°±5.7°，P＜0.05）；伴脊髓空洞的成人CMⅠ组患者斜坡倾斜角（45.8°±7.6°）较单纯CMⅠ组（49.7°±5.1°）显著减小；Ⅱ度扁桃体下疝CMⅠ患者的后颅窝斜坡长度（31.4±3.6mm）及倾斜角（42.3°±5.4°）明显小于Ⅰ度扁桃体下疝CMⅠ患者（36.2±3.8mm、48.1°±5.2°；P＜0.05），余指标未见明显差异。结论：成人CMⅠ患者的后颅窝容积明显减少，但与脊髓空洞和扁桃体下疝程度之间无显著相关性；CMⅠ患者斜坡发育不良与脊髓空洞的形成以及小脑扁桃体下疝程度存在一定相关性。展开更多
目的:通过对ChiariⅠ畸形合并脊髓空洞症手术治疗临床路径与DRGs(Diagnosis Related Groups)成本控制绩效分析,评价单病种临床路径和DRGs医疗成本控制应用于临床管理的效果。方法:收集整理2005年10月至2006年9月脊髓空洞症科ChiariⅠ畸...目的:通过对ChiariⅠ畸形合并脊髓空洞症手术治疗临床路径与DRGs(Diagnosis Related Groups)成本控制绩效分析,评价单病种临床路径和DRGs医疗成本控制应用于临床管理的效果。方法:收集整理2005年10月至2006年9月脊髓空洞症科ChiariⅠ畸形合并脊髓空洞症手术治疗患者的信息,以其手术并发症发生率、平均住院天数、平均住院费用、患者满意率等作为评价指标,将实验组(应用临床路径和DRGs成本控制组)和对照组(未应用临床路径和DRGs成本控制组)进行对比分析。结果:应用临床路径和DRGs成本控制的患者与未应用这一方式的患者之间在手术并发症发生率、平均住院时间、平均住院费用、患者满意率方面有统计学显著差异。结论:单病种临床路径和DRGs成本控制模式应用于ChiariⅠ畸形合并脊髓空洞症手术治疗,可以明显促进CQI(Continuous Quality Improvement)、缩短平均住院时间,降低住院费用,提高患者满意率。展开更多
文摘Objective:To identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1.Method:Patients who were clinically suspected to have Chiari malformation type 1 and were referred to the Department of Radiology between 2007 and 2020,and whose diagnosis was radiologically confirmed through magnetic resonance imaging(MRI),were retrospectively evaluated.A total of 49 Chiari malformation type 1 patients with both cervical and cerebral examinations and 49 control subjects of the same age and gender without a diagnosis of Chiari malformation type 1 were included in the study.In Chiari malformation type 1 diagnosed patients,the presence of pseudotumor cerebri,the presence of syringomyelia in cervical spinal MRI images,and the distance of cerebellar tonsils and obex according to McRae line were evaluated in millimeters.Result:In Chiari malformation type 1 clinically and radiologically diagnosed cases,the cerebellar tonsils and obex were located lower in patients with a radiological diagnosis of pseudotumor cerebri compared to those without,and the rate of accompanying syringomyelia appeared to be higher.However,no statistically significant difference was observed between the two groups.Conclusion:The coexistence of pseudotumor cerebri and Chiari malformation type 1 is more common than previously estimated.Different treatment protocols in the coexistence of pseudotumor cerebri and Chiari malformation type 1 emphasize the importance of making this diagnosis.Further radiological imaging studies are needed to identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1.
基金This project was supported by grants from the National Natural Science Foundation of China （No. 81702478 and No. 81270865） and China Postdoctoral Science Foundation （No. 2016M600596）.
文摘A growing number of children and adolescents are being diagnosed as Chiari malformation type I （CM- I ） for behavioral disorders, developmental delay, seizures, or abnormal orpharyngeal function. The aim of this study was to compare the clinical characteristics, imaging findings and surgical outcomes of CM- I in pediatric and adult patients. Between January 2014 and June 2017, 84 patients with CM- I underwent surgical treatment in our department. We divided the patients into two groups： pediatric group （n=l 1, age 〈18 years） and adult group （n=73, age 〉18 years）. Data on clinical characteristics, imaging findings, surgical outcomes, and prognosis were retrospectively reviewed and compared between these two groups. For clinical presentation, scoliosis （36.4%） and developmental delay （36.4%） were more common in pediatric patients, whereas, sensory disturbance （58.9%） and motor weakness （41. 1%） were more common in adult patients. Imaging findings showed that the incidence of hydrocephalus and craniovertebral junctional abnormalities was significantly higher in pediatric group than in adult group （P〈0.05）. Compared to adult group, pediatric group showed a better improvement or resolution of syrinx and tonsillar herniation after surgical treatments （P〈0.05）. The total Chicago Chiari Outcome Scale （CCOS） score in pediatric patients at the last follow- up was significantly higher than that in adult patients （P=0.002）. In conclusion, the clinical characteristics and imaging findings appeared to be different in pediatric and adult patients with CM- I. The surgical outcomes of pediatric patients were shown to be significantly better than those of adult patients.
文摘<strong>Aim of the work:</strong> This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological follow up in adults.<strong> Patients and methods: </strong>This study included 30 consecutive patients with Chiari malformation type I who were indicated for surgery at neurosurgery department. Data were collected prospectively from the involved patients who were evaluated preoperatively and underwent evaluation by CT scanning of the brain & skull and MRI imaging of the brain and spine. CT and MRI were done as the routine follow up investigations for all patients. We operated through midline suboccipital craniectomy, durotomy in y shaped manner, shrinkage of cerebellar tonsils by bipolar electrocautery, duroplasty by fascia lata graft, watertight closure. <strong>Results: </strong>The assessment from E. J. N. S. (Egyptian Journal of Neurosurgery) vol. 24 no. 2 June 2009 used for evaluating the patients clinically. 18 patients reported good outcome, 6 fair, 6 poor. We evaluated the size of the syrinx if present preoperative in follow up. 15 (50%) patients showed marked reduction (more than or equal to 60%) in size of syrinx, 3 (10%) mild reduction (less than or equal to 30%) in size and 12 (40%) with no change. <strong>Conclusion:</strong> The Chiari type 1 malformation constitutes a controllable malformation with good outcomes. With current microsurgical techniques, the results of the bony decompression and duroplasty became excellent. Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications.
文摘目的：探讨成人Chiari畸形Ⅰ型（Chiari malformation type Ⅰ，CMⅠ）患者后颅窝线性容积特征及其与脊髓空洞和小脑扁桃体下疝程度之间的相关性。方法：收集2010年6月~2014年6月在我院接受治疗的CMⅠ患者，入选标准为：（1）年龄＞30岁；（2）经头颈部MRI确诊为CMⅠ伴或不伴脊髓空洞；所有入选患者均排除颅内占位性病变、颅骨破坏、后颅窝手术史或获得性Chiari畸形。选取年龄匹配的正常成人作为对照组，测量两组头颅正中矢状位MRI中斜坡长度、枕骨大孔横径、枕上长度、后颅窝矢状径、后颅窝高径和后颅窝斜坡倾斜角α等指标，并将两组按性别分组后比较后颅窝线性容积差异。同时根据小脑扁桃体下疝程度及是否伴发脊髓空洞进行分组，分析后颅窝线性容积特征与小脑扁桃体下疝程度及脊髓空洞的关系。结果：共纳入CMⅠ患者37例，男18例，女19例；年龄38.5±5.5岁（31～56岁）。正常对照组41例，男19例，女22例；年龄36.4±6.3岁（33～58岁），成人CMⅠ患者后颅窝斜坡长度、枕上长度、后颅窝矢状径、后颅窝高径及斜坡倾斜角分别为35.9±4.2mm、38.2±5.8mm、77.4±6.1mm、28.2±3.9mm和47.4°±6.4°，均明显小于正常对照组（43.3±2.9mm、43.5±5.6mm、82.5±4.5mm、35.4±3.4mm、58.6°±5.7°，P＜0.05）；伴脊髓空洞的成人CMⅠ组患者斜坡倾斜角（45.8°±7.6°）较单纯CMⅠ组（49.7°±5.1°）显著减小；Ⅱ度扁桃体下疝CMⅠ患者的后颅窝斜坡长度（31.4±3.6mm）及倾斜角（42.3°±5.4°）明显小于Ⅰ度扁桃体下疝CMⅠ患者（36.2±3.8mm、48.1°±5.2°；P＜0.05），余指标未见明显差异。结论：成人CMⅠ患者的后颅窝容积明显减少，但与脊髓空洞和扁桃体下疝程度之间无显著相关性；CMⅠ患者斜坡发育不良与脊髓空洞的形成以及小脑扁桃体下疝程度存在一定相关性。
文摘目的:通过对ChiariⅠ畸形合并脊髓空洞症手术治疗临床路径与DRGs(Diagnosis Related Groups)成本控制绩效分析,评价单病种临床路径和DRGs医疗成本控制应用于临床管理的效果。方法:收集整理2005年10月至2006年9月脊髓空洞症科ChiariⅠ畸形合并脊髓空洞症手术治疗患者的信息,以其手术并发症发生率、平均住院天数、平均住院费用、患者满意率等作为评价指标,将实验组(应用临床路径和DRGs成本控制组)和对照组(未应用临床路径和DRGs成本控制组)进行对比分析。结果:应用临床路径和DRGs成本控制的患者与未应用这一方式的患者之间在手术并发症发生率、平均住院时间、平均住院费用、患者满意率方面有统计学显著差异。结论:单病种临床路径和DRGs成本控制模式应用于ChiariⅠ畸形合并脊髓空洞症手术治疗,可以明显促进CQI(Continuous Quality Improvement)、缩短平均住院时间,降低住院费用,提高患者满意率。
