Tube-assisted minimally invasive posterior decompression for Chiari Ⅰ malformation

LEI Wei; SONG Zhenquan; LI Jinjiang; LI Jingyuan; ZHANG Xiaobin; PAN Dongsheng

Abstract：Objective To evaluate the clinical outcomes of minimally invasive posterior fossa decompression surgery assisted by a tubular retractor system for the treatment of Chiari Type Ⅰ malformation(CM-1).Methods Between March 2020 and February 2021,20 adult patients with CM-1 underwent posterior fossa decompression surgery assisted by a tubular retractor system at the Department of Neurosurgery,Northern Theater Command General Hospital.Thirteen cases were performed under microscopic guidance,and seven cases under endoscopic guidance.This study retrospectively analyzed pre-and postoperative neurological functions,imaging findings,postoperative complications,and the cervical Japanese Orthopedic Association(JOA)scores at 12-month follow-up.Results All of the 20 patients showed varying degrees of symptom improvement postoperatively,with an average cervical JOA recovery rate of 65.3％.Postoperative MRI of the syrinx revealed complete resolution in three cases,reduction in 16 cases,and no change in one case.There were three cases of postoperative epidural fluid accumulation and one case of mild infection,with no case requiring further surgery.Conclusions Minimally invasive posterior fossa decompression surgery for Chiari Type Ⅰ malformation assisted by a tubular retractor system effectively reduces the syrinx,alleviates spinal cord compression,and improves clinical symptoms.This surgical approach is characterized by minimal muscle injury and rapid recovery,making it a safe and effective treatment method for Chiari Ⅰ malformation.