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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Comparison of operative and non-operative outcomes based on surgical selection criteria for patients with Chiari I malformations
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Comparison of operative and non-operative outcomes based on surgical selection criteria for patients with Chiari I malformations

机译：根据手术选择标准对Chiari I畸形患者进行手术和非手术结果的比较

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Few studies have directly compared operative and non-operative outcomes in Chiari I patients. We evaluated risk factors for clinical improvement in 177 patients in order to help determine the optimal treatment of these often difficult to treat patients. The mean age at surgery for the operative treatment group was 29.9 years. The most common presenting signs and symptoms included cough headache (63.0%), migraine and non-cough type headaches (23.9%), paresthesias (32.1%), and abnormal reflexes or clonus (27.5%). The mean age of diagnosis for the non-operative treatment group was 30.2 years. The most common presenting signs or symptoms included migraine and other types of non-cough-associated headache (57.4%), paresthesias (45.6%), cough headache (44.1%), cerebellar signs or symptoms (41.2%), and dysphagia or apnea (15.7%). A propensity score was generated using cough headache, any headache, other headache, syrinx, abnormal reflexes or clonus, cerebellar symptoms, and miscellaneous symptoms as independent predictors of selection for surgery. The propensity score-adjusted odds of overall improvement for patients treated with surgery were 16.5 times the odds of overall improvement for patients treated conservatively (95% confidence interval 5.5-57.1, p <0.0001). Overall 94.5% and 47.1% of operative and conservatively treated patients reported improvement, respectively. Only 26.5% of conservatively treated patients reported worsening of any of their symptoms. In conclusion, we provided further evidence for the use of cough headache as surgical indication for suboccipital decompression in patients with Chiari I malformation. (C) 2014 Elsevier Ltd. All rights reserved.
机译：很少有研究直接比较Chiari I患者的手术和非手术结果。我们评估了177例患者临床改善的危险因素，以帮助确定这些通常难以治疗的患者的最佳治疗方法。手术治疗组的平均手术年龄为29.9岁。最常见的体征和症状包括咳嗽头痛（63.0％），偏头痛和非咳嗽型头痛（23.9％），感觉异常（32.1％）以及反射异常或阵挛（27.5％）。非手术治疗组的平均诊断年龄为30.2岁。最常见的体征或症状包括偏头痛和其他类型的非咳嗽相关性头痛（57.4％），感觉异常（45.6％），咳嗽头痛（44.1％），小脑体征或症状（41.2％）以及吞咽困难或呼吸暂停（15.7％）。使用咳嗽头痛，任何头痛，其他头痛，syrinx，反射异常或阵挛，小脑症状和其他症状作为手术选择的独立预测因子，得出倾向评分。经手术治疗的患者的倾向得分调整后的总体改善几率是保守治疗的患者的总体改善几率的16.5倍（95％置信区间5.5-57.1，p <0.0001）。分别有94.5％和47.1％的手术和保守治疗患者报告有所改善。在保守治疗的患者中，只有26.5％的患者报告其症状有所恶化。总之，我们为Chiari I畸形患者使用咳嗽性头痛作为枕下减压的手术指征提供了进一步的证据。 （C）2014 Elsevier Ltd.保留所有权利。

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