症状谱：成人1型Chiari畸形手术结局的术前症状相关指标

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中文摘要

成人1型Chiari畸形（C1M）可能因出现致残性神经系统症状而需要手术减压。成人C1M手术治疗的结局存在差异，且单个症状的预测价值研究较少。本研究对2004年至2024年间在本机构接受后颅窝减压手术（PFDS）的成人C1M患者（≥18岁）进行了回顾性队列研究。采用单因素和多因素分析，评估术前C1M相关症状对术后临床医生记录结局及30天、90天和长期随访时症状完全缓解的预测价值。共209例成人C1M患者接受了PFDS，中位年龄36岁，男女比例为1:4.9。头痛是最常见的首发症状（91.4%），其中62.3%的头痛患者存在咳嗽性头痛。多因素回归分析确定术前睡眠呼吸暂停（OR=6.55，95% CI：1.16-37.05）、失衡（OR=2.33，95% CI：1.12-4.84）和耳鸣（OR=2.81，95% CI：1.14-6.89）是30天随访时症状改善的预测因素，而吞咽困难（OR=5.80，95% CI：1.39-24.12）是90天随访时的预测因素。术前听力损失的患者在长期随访中更可能出现症状复发（OR=4.55，95% CI：1.04-19.77）。手部麻木/无力和视觉症状是仅有的两个预测最终随访时症状完全缓解几率较低的术前症状（OR分别为0.50和0.42）。若干临床因素与C1M患者PFDS术后症状结局相关。这些关联应被视为产生假设，在临床应用前需要前瞻性验证。

英文摘要

Chiari I malformation (C1M) may necessitate surgical decompression in adulthood due to the emergence of debilitating neurological symptoms. The outcomes of surgical management for C1M in the adult population are variable and predictive value of individual symptoms has been less extensively studied. A retrospective cohort study was conducted on adult patients (≥ 18 years) who underwent posterior fossa decompression surgery (PFDS) for C1M at our institution between 2004 and 2024. Univariate and multivariate analyses were performed to evaluate the predictive value of preoperative C1M-related symptoms on postoperative clinician-documented outcomes and complete symptom resolution at 30-, 90-day, and long-term follow-up. A total of 209 adult patients underwent PFDS for C1M, with a median age of 36 years and a male-to-female ratio of 1:4.9. Headache was the most common presenting symptom (91.4%), with tussive headaches present in 62.3% of cases with headache. Multivariate regression analysis identified preoperative sleep apnea (OR = 6.55, 95% CI: 1.16-37.05), imbalance (OR = 2.33, 95% CI: 1.12-4.84), and tinnitus (OR = 2.81, 95% CI: 1.14-6.89) as predictors of symptom improvement at 30-days follow-up, while dysphagia (OR = 5.80, 95% CI: 1.39-24.12) was predictive at 90-days. Patients with preoperative hearing loss were more likely to experience symptom recurrence during long-term follow-up (OR = 4.55, 95% CI: 1.04-19.77). Hand numbness/weakness and visual symptoms were the only two preoperative symptoms predictive of a lower odds of complete symptom resolution at the final follow-up (OR = 0.50 and OR = 0.42, respectively). Several clinical factors were associated with postoperative symptom outcomes after PFDS for C1M. These associations should be considered hypothesis-generating and require prospective validation before clinical application.