微创枕大池重建术辅助术中B超评价ChiariI型畸形合并脊髓空洞症临床疗效

目的探讨微创枕大池重建术治疗ChiariI型畸形术中辅助B超判断枕大池重建效果的可行性。方法选择2008年1—12月诊断明确的ChiariI型畸形合并脊髓空洞症患者共93例，施行微创枕大池重建术。术中保留寰椎后弓，并于切开硬膜前通过B超实时观察小脑扁桃体下疝形态、大小、“活塞”样往复运动状态，以及枕大池形态和大小；并于切除部分小脑扁桃体后对枕大池重建效果进行判断。分别于术后6和30个月时通过Tator法进行临床疗效评价。结果所有患者均顺利完成手术，术后并发症包括小脑出血（1例）、小脑梗死（1例）、脑积水（1例）、皮下积液（2例），均经对症治疗痊愈出院。术后6个月随访93例患者，临床症状好转36例、稳定55例、加重2例，MRI显示脊髓空洞缩小或完全消失90例、无变化3例；术后30个月随访80例患者，原症状稳定者中12例好转、1例加重，MRI显示脊髓空洞无进一步变化。结论微创枕大池重建术治疗ChiariI型畸形损伤小、术后恢复迅速、效果稳定、并发症少、安全性高。术中通过B超判断枕大池重建效果简单易行，数据可靠。

The efficacy of intraoperative ultrasonography-assisted microinvasive cisterna magna reconstruction for Chiari malformation type I with syringomyelia

Objective To report the method and effect of intraoperative ultrasonography-assisted microinvasive cisterna magna reconstruction for Chiari malformation type I with syringomyelia. Methods Ninty-three patients suffered from Chiari malformation type I with syringomyelia were treated by microinvasive cisterna magna reconstruction. The skin incision was 1.50-3.00 cm. The bone removal of foramen magnum was 1.50 cm × 2.00 cm with C1 reserved. Dura and arachnoid were incised and sutured linearly. All of the patients underwent cerebellar tonsillar resection and exploration of median aperture of fourth ventricle. Intraoperative ultrasonography was performed both before and after cerebellar tonsillar resection to judge the effect of eisterna magna reconstruction. According to Tator method, the curative effect was divided into 3 groups, improved, stable and worsen. MRI were reviewed at the same time, and the result was divided into syrinx disappeared, reduced, no change and expanded. Results The operation was successful in all patients. Postoperative complications included cerebellum hemorrhage （n = 1）, cerebral infarction （n = 1）, hydrocephalus （n = 1）, subcutaneous dropsy （n = 2） and were recovered after specific treatment. All patients were followed up for 6 months to 12 months after operation. Thirty-six cases were improved, 55 eases were stable, and 2 eases got worse. The MRI showed that the syringomyelia shrinked or disappeared in 90 eases, no change in 3 eases and no expansion. Eighty eases were followed up for 30 months to 36 months after operation, 12 stable eases improved, 1 stable case got worse, while the others remained unchanged. The MRI showed no change was compared with previous follow- up imaging. Conclusion Microinvasive cisterna magna reconstruction is a surgical procedure with mininal injury, quick recovery, stable effect, fewer complications, and high security. Intraoperative uhrasonography provides reliable data and is easy to perform.