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A novel classification and its clinical significance in Chiari I malformation with syringomyelia based on high-resolution MRI

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A Correction to this article was published on 10 April 2021

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Abstract

Background

The existing classification in Chiari I malformation (CM-I) has limited significance for the selection of surgical methods.

Objective

The purpose of this study was to investigate the surgery of CM-I with syringomyelia based on the high-resolution MR imaging (HRMRI) findings.

Methods

Data from 115 patients were collected and retrospectively analyzed. For those with syringomyelia up to the level of C1, HRMRI was performed and according to the communication status between the fourth ventricle and the syringomyelia, patients can be divided into four types, namely Type A: classic communicating; Type B: partial communicating; Type C: non-communicating; Type D: atrophic. All operations were performed with Foramen magnum and Magendie dredging (FMMD), and all intradural factors that may have induced the obstruction of CSF circulation were recorded. The efficiency of operation on syringomyelia was evaluated by mJOA, imaging findings, and complications in the follow-up periods.

Results

The postoperative follow-up period was from 12 to 24 months, with an average of 14.3 months. At 1 year, the mJOA of 115 patients was significantly higher than that before the operations (before surgery 12.1 ± 2.3 vs. after surgery 14. 2 ± 1.4, P < 0.05). In addition, postoperative re-examination showed that the size of the syringomyelia was reduced or completely resolved in patients of Type A, 100% (2/2); Type B, 81% (9/11); Type C, 84% (81/97); and Type D, 20% (1/5).

Conclusions

According to our new classification based on HRMRI, FMMD is the key to surgical treatment, especially for Type A and Type B patients.

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Acknowledgements

We thank Xu shenglong for English language editing.

Funding

This study was supported by “Yang fan” project of Beijing medical management center in 2021 (XMLX202138), Beijing Municipal Health Commission (Beijing Health Commission Independent Innovation Fund 2018-2-2014), Beijing Municipal Administration of Hospitals (Beijing Natural Science Foundation Grant, 7172091), Beijing Municipal Science and Technology Commission Grant numbers: Z191199996619048, and Beijing Municipal Commission of Education Grant numbers: KZ202010025043, 1192070315.

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Author notes

  1. Jian Guan and Chenghua Yuan have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Division of Spine, China, International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People’s Republic of China

    Jian Guan, Chenghua Yuan, Can Zhang, Longbing Ma, Qingyu Yao, Lei Cheng, Zhenlei Liu, Kai Wang, Wanru Duan, Xingwen Wang, Zuowei Wang, Hao Wu, Zan Chen & Fengzeng Jian

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  1. Jian Guan
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  2. Chenghua Yuan
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  3. Can Zhang
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Correspondence to Zan Chen or Fengzeng Jian.

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The study was approved by the institutional research ethics committee of Xuanwu Hospital.

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Guan, J., Yuan, C., Zhang, C. et al. A novel classification and its clinical significance in Chiari I malformation with syringomyelia based on high-resolution MRI. Eur Spine J 30, 1623–1634 (2021). https://doi.org/10.1007/s00586-021-06746-y

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