neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-23-1-83-90neurosurgery-1014Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTРезультаты хирургического лечения пациентов с базилярной инвагинацией, ассоциированной с аномалией Киари I типаResults of surgical treatment of patients with basilar invagination associated with type I Chiari malformationhttps://orcid.org/0000-0001-8895-3196ЕпифановД. С.EpifanovD. S.

Дмитрий Сергеевич Епифанов

Россия, 105203 Москва, ул. Нижняя Первомайская, 70

Dmitry Sergeevich Epifanov

70 Nizhnyaya Pervomayskaya St., Moscow 105203, Russia

doc.neuros@gmail.comhttps://orcid.org/0000-0002-3372-2670ЛебедевВ. Б.LebedevV. B.

Россия, 105203 Москва, ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203, Russia

https://orcid.org/0000-0003-2974-1462ЗуевА. А.ZuevA. A.

Россия, 105203 Москва, ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203, Russia

ФГБУ «Национальный медико-хирургический центр им. Н. И. Пирогова» Минздрава РоссииРоссияN. I. Pirogov National Medical and Surgical Center, Ministry of Health of RussiaRussian Federation20210405202123183‑90Copyright © Епифанов Д.С., Лебедев В.Б., Зуев А.А., 20212021Епифанов Д.С., Лебедев В.Б., Зуев А.А.Epifanov D.S., Lebedev V.B., Zuev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1014Введение

Введение. Каждая из указанных в заголовке статьи патологий редка и может приводить к компрессии ствола головного и спинного мозга с развитием «смешанной» клинической картины. Тактика лечения пациентов с сочетанием этих патологий, предлагаемая разными авторами, существенно отличается.

Цель публикации – обобщить собственный опыт лечения пациентов с базилярной инвагинацией, ассоциированной с аномалией Киари I типа, и сопоставить результаты с данными научной литературы.

Материалы и методы

Материалы и методы. С 2014 по 2019 г. в Национальном медико-хирургическом центре им. Н. И. Пирогова было проведено хирургическое лечение 3 пациентов с сочетанием базилярной инвагинации и аномалии Киари I типа. Показаниями к операции были длительно прогрессирующие неврологические нарушения и неэффективность консервативной терапии. Выполнена передняя эндоскопическая трансназальная и задняя декомпрессия нервных структур с последующей стабилизацией.

Результаты

Результаты. Состояние всех пациентов оценено через 12 мес после операции. У всех пациентов наблюдалась положительная динамика неврологического статуса. По данным магнитно-резонансной томографии краниовертебрального сочленения у 2 пациентов констатирована положительная динамика: регресс очага миелопатии, уменьшение диаметра сирингомиелической кисты.

Заключение

Заключение. Передняя эндоскопическая трансназальная декомпрессия нервных структур показана при преобладании в клинической картине бульбарных нарушений и / или парезов конечностей, задняя декомпрессия – при наличии специфических симптомов аномалии Киари I типа и / или сирингомиелии. Принимая во внимание результаты последних исследований, можно предположить, что стабилизация является необходимой составляющей лечения пациентов с данными патологиями.

Introduction

Introduction. Each of the pathologies is rare and can lead to compression of the brainstem and spinal cord, with the development of a “mixed” clinical picture. The tactics of treating such patients differs from one author to another.

The objective is to present the author’s experience in treating patients with basilar invagination associated with type I Chiari malformation and to analyze the literature on the methods of surgical treatment of this pathology.

Materials and methods

Materials and methods. From 2014 to 2019, 3 patients with a basilar invagination and type I Chiari malformation were surgically treated at the N. I. Pirogov National Medical and Surgical Center. Indications for surgical intervention were long-term progressive neurological disorders, lack of effect from conservative therapy. Patients underwent anterior transnasal and posterior decompression of nerve structures followed by stabilization.

Results

Results. All patients were evaluated 12 months after surgery. All patients in neurological status showed positive dynamics. According to magnetic resonance imaging of the craniovertebral junction, 2 patients showed positive dynamics: regression of the myelopathy, a decrease in the diameter of the syringomyelic cyst.

Conclusion

Conclusion. The criteria for anterior transnasal decompression are the predominance of bulbar disorders and / or paresis in the extremities in the clinical picture; posterior decompression of nerve structures, indicated in the presence of specific symptoms of type I Chiari malformation and / or syringomyelia. Taking into account the results of the latest published studies it can be assumed that stabilization is a necessary option in the treatment of patients with this pathology.

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The authors declare that there are no conflicts of interest present.