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《Complex Chiari malformations in children an analysis of preoperative risk factors for occipitocervical fusion.》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。
1、JNeurosurgPediatrics10:134–141,2012ComplexChiarimalformationsinchildren:ananalysisofpreoperativeriskfactorsforoccipitocervicalfusionClinicalarticleRobeRtJ.bollo,M.D.,JayRiva-CaMbRin,M.D.,M.SC.,MeghanM.bRoCkMeyeR,anDDouglaSl.bRoCkMeyeR,M.D.DivisionofPediatricNeurosurgery,Dep
2、artmentofNeurosurgery,PrimaryChildren’sMedicalCenter,UniversityofUtah,SaltLakeCity,UtahObject.ChiarimalformationTypeI(CM-I)isacongenitalanomalyoftentreatedbydecompressivesurgery.Patientswhofailtorespondtostandardsurgicalmanagementoftenhavecomplexanomaliesofthecraniovertebra
3、ljunctionandbrainstemcompression,requiringreductionandoccipitocervicalfusion.Theauthorshypothesizedthatasubgroupof“complex”patientsdefinedbyspecificradiographicriskfactorsmayhaveahigherrateofrequiringoccipitocervicalfusion.Methods.Aretrospectivereviewwasconductedofclinicala
4、ndradiographicdatainpediatricpatientsundergo-ingsurgeryforCM-Ibetween1995and2010.Thefollowingradiographiccriteriawereidentified:scoliosis,syringo-myelia,CMType1.5,medullarykinking,basilarinvagination,tonsillardescent,craniocervicalangulation(clivoaxialangle[CXA]<125°),andve
5、ntralbrainstemcompression(pB–C2≥9mm).AmultivariateCoxregressionanalysiswasusedtodeterminetheindependentassociationbetweenoccipitocervicalfusionandeachvariable.Results.Ofthe206patientswhounderwentCMdecompressionwithorwithoutoccipitocervicalfusionduringthestudyperiod,101hadpr
6、eoperativeimagingavailableforreviewandformedthestudypopulation.Meanageatsurgerywas9.1years,andmeanfollow-upwas2.3years.Eighty-twopatientsunderwentsuboccipitaldecompres-sionalone(meanage8.7years).Nineteenpatientsunderwentoccipitocervicalfusion(meanage11.1years),eitherasparto
7、ftheinitialsurgicalprocedureorinadelayedfashion.Factorsdemonstratingasignificantlyincreasedriskofrequiringfusionwerebasilarinvagination(HR9.8,95%CI2.2–44.2),CM1.5(HR14.7,95%CI1.8–122.5),andCXA<125°(HR3.9,95%CI1.2–12.6).Conclusions.Patientspresentingwithbasilarinvagination,C
8、M1.5,andCXA<125°areatincreasedriskofrequiringanoccipitocervicalfusionprocedureeith
