Chiari I畸形合并脑积水的手术治疗(附33例报告)

目的　研究Chiari I畸形合并脑积水的手术方式和手术方法,并评价手术效果。方法　回顾性分析33例Chiari I畸形合并脑积水患者,全部病例均采用后颅凹减压术并在显微镜、脑室镜等辅助下切除下疝的小脑扁桃体并松解去除脑室系统内外粘连,使用神经补片减张缝合硬膜。术前术后分别作MR和脑室系统径线的测量比较并随访复查。结果　全部病例MR显示颈延髓压迫解除,枕大池形态恢复,2 3例症状明显改善,2 5例脑室明显缩小,6例脑室系统变化不显著,2例脑积水仍有发展。结论　Chiari I畸形合并脑积水以梗阻因素为主,术中除作好骨性结构的充分减压外,还应松解粘连、解除梗阻并重建枕大池,争取在手术中一次性解决颈延髓压迫和脑积水两个问题。

Surgical treatment for Chiari I malformation with hydrocephalus:33 cases report.

Objective To investigate the operational methods and techniques on Chiari I malformation with hydrocephalus and evaluate the surgical outcomes. Methods 33 cases of Chiari I malformation with hydrocephalus were analyzed retrospectively. Posterior fossa decompression was performed in all cases,displaced tonsils and ventricular adhesion were removed with aid of surgical microscope. Neuroendoscope,and neuropatches were used to close the dura. Ventricular mesurement on MR imaging was made before and after operation for comparison. Results In all cases,the brain stems and cervical spine were well decompressed,and the shapes of cistern magnum recovered on MR imaging. The symptoms improved in 23 of cases. The ventricular volume was shrinked significantly in 25 cases, but not changed in 6 cases, and still in progress in 2 cases. Conclusions Chiari I malformation with hydrocephalus is mainly due to obstructive factors. In addition to the decompression of posterior fossa bone structure,it is also necessary to remove the ventricular adhesion and reconstruct cistern magnum.According to different kind and area of obstruction, appropriate methods and techniques should be taken so that the cure of hydrocephalus and decompression can be achieved in one operation.