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<p>The uniform and optimal management of Chiari malformation type 1 (CM1) has not yet been established. The study aimed to investigate the clinical characteristics and surgical outcomes of patients with CM1 in China.&#xa0;Data from 827 patients who underwent various surgical procedures for CM1 across 14 centres in China were analysed. Clinical characteristics were evaluated, and the inverse probability of treatment weights methods was applied to estimate the relationships between risk factors and functional outcomes.&#xa0;Syringomyelia was observed in most cases (754; 91.17%) in this cohort. A positive correlation was found between disease duration and age at diagnosis (<i>P</i> = 0.0002). Conversely, disease duration showed a significant negative correlation with preoperative Japanese Orthopaedic Association (JOA) score (<i>P</i> &lt; 0.0001), postoperative JOA score (<i>P</i> &lt; 0.0001), and Chicago Chiari Outcome Scale score. Patients who underwent posterior fossa decompression with tonsil resection/cautery (PFDRT) surgery had the highest mean postoperative JOA score (15.51 ± 1.84) compared with those in the posterior fossa decompression (PFD), posterior fossa decompression with duraplasty, and other groups (<i>P</i> = 0.0297). Postoperative complications were more frequent after PFDRT than after PFD (<i>P</i> = 0.0443). However, the reoperation rate of PFDRT was significantly lower than that for PFD (<i>P</i> = 0.0057).&#xa0;Surgeries providing adequate cerebrospinal fluid decompression yielded superior outcomes compared with simple bony decompression or cerebrospinal fluid shunting. Age at diagnosis, craniocervical malformation, disease duration, and surgical approach are key factors influencing CM1 outcomes.&#xa0;Chinese Clinical Trial Registry, Number: ChiCTR2400080007, Registered on January 18th, 2024.</p>

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Cohort analysis of surgically managed Chiari malformation type 1: real-world data from multi-centres

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Fang Wang,
  • Mingkun Wei,
  • Dingkang Xu,
  • Zikuo Wang,
  • Jichao Yang,
  • Yongli Lou,
  • Lei Hui,
  • Shuangzhu Yue,
  • Yongsheng Liu,
  • Zhen Yang,
  • Yuanfeng Zhang,
  • Yitong Wei,
  • Yansheng Gao,
  • Qinglin Wang,
  • Shengqi Zhao,
  • Xiaolong Guo,
  • Jinsong Wu,
  • Qingjie Wei,
  • Yanpeng Jian,
  • Kangqi Ji,
  • Qiao Shan,
  • Jinyu Liu,
  • Li Jian,
  • Haojun You,
  • Qinghe Yao,
  • Jiali Yao,
  • Shubin Feng,
  • Qiang Feng,
  • Dandong Fang,
  • Yuan An,
  • Yan Du,
  • Mingchu Zhang,
  • Kaiyuan Zhang,
  • Junhao Fang,
  • Mengzhao Feng,
  • Mengyuan Li,
  • Dengpan Song,
  • Bangqing Wang,
  • Kai Yin,
  • Yan Hu,
  • Yuchao Zuo,
  • Bin Yu,
  • Weiguang Wang,
  • Ruixia Yuan,
  • Ali Çağlar Turgut,
  • Cenk Eraslan,
  • Jun Zhang,
  • Jorge A. Lazareff,
  • Fuyou Guo

摘要

The uniform and optimal management of Chiari malformation type 1 (CM1) has not yet been established. The study aimed to investigate the clinical characteristics and surgical outcomes of patients with CM1 in China. Data from 827 patients who underwent various surgical procedures for CM1 across 14 centres in China were analysed. Clinical characteristics were evaluated, and the inverse probability of treatment weights methods was applied to estimate the relationships between risk factors and functional outcomes. Syringomyelia was observed in most cases (754; 91.17%) in this cohort. A positive correlation was found between disease duration and age at diagnosis (P = 0.0002). Conversely, disease duration showed a significant negative correlation with preoperative Japanese Orthopaedic Association (JOA) score (P < 0.0001), postoperative JOA score (P < 0.0001), and Chicago Chiari Outcome Scale score. Patients who underwent posterior fossa decompression with tonsil resection/cautery (PFDRT) surgery had the highest mean postoperative JOA score (15.51 ± 1.84) compared with those in the posterior fossa decompression (PFD), posterior fossa decompression with duraplasty, and other groups (P = 0.0297). Postoperative complications were more frequent after PFDRT than after PFD (P = 0.0443). However, the reoperation rate of PFDRT was significantly lower than that for PFD (P = 0.0057). Surgeries providing adequate cerebrospinal fluid decompression yielded superior outcomes compared with simple bony decompression or cerebrospinal fluid shunting. Age at diagnosis, craniocervical malformation, disease duration, and surgical approach are key factors influencing CM1 outcomes. Chinese Clinical Trial Registry, Number: ChiCTR2400080007, Registered on January 18th, 2024.