Changes of swallowing function and their significance in Chiari I malformation patients with dysphagia after decompression surgery

Objective:To survey changes of swallowing function and their significance in Chiari Ⅰ malformation patients with dysphagia after Atlanto-occipital Decompression with Duraplasty by comparing water swallowing test results and other clinical features before and after surgery.Methods: From January 2007 to July 2010,126 Chiari Ⅰmalformation patients were treated in Neurosurgery Department of Peking University Third Hospital.Clinical data were prospectively analyzed.There were 34 cases(26.9%,34/126) with varying severity of dysphagia.All of those patients underwent Atlanto-occipital Decompression with Duraplasty.Water swallowing tests were performed 1 day before operation and after 7-10 days to assess dysphagia severity.The improvements of other major symptoms and signs after surgery were also compared.Results: Postoperative dysphagia was improved in 23 cases(67.6%,23/34),and drinking water test score of preoperation was(2.74±1.11).The score was significantly reduced to(1.71±0.91) after the operation(P0.05).Other major symptoms and signs were analyzed by Fisher's exact test which showed that only neck and shoulder pain(P=0.01) improved significantly,compared with preoperation.Conclusion: Indeed part of the Chiari Ⅰmalformation patients suffer from varying severity of dysphagia.The detailed clinical history collection and physical examination may improve the initial detection rate of dysphagia.Water swallow test is useful to quantify the degree of dysphagia.Atlanto-occipital Decompression with Duraplasty can improve treatment of Chiari Ⅰmalformation patients with dysphagia.Improvement in treating dysphagia shortly after operation may be an effective index to evaluate the effect of surgery.