Chiari畸形颅后窝减压及重建显微手术的临床研究

目的探讨Chiari畸形颅后窝减压及重建显微手术方法。方法回顾性分析70例Chiari畸形行显微手术的病例资料。均行颅后窝减压，皮质下切除下疝小脑扁桃体，人工硬膜无张力缝合，扩大骨瓣回置。结果术后症状消失或改善68例（97．1％），无变化2例。59例随访1个月～3．5年，平均1年，53例症状消失或改善，4例病情稳定，2例神经功能恶化，有效率96．6％。54例合并脊髓空洞，空洞明显缩小或消失52例（96-3％），无变化1例，空洞扩大l例。结论颅后窝减压及重建显微手术重点是解除枕大孔区压迫、重建脑脊液流体力学，是治疗Chi撕畸形有效方法。

A clinical study of posterior fossa decompression and microsurgical reconstruction for Chiari malformation

Objective To explore microsurgical methods for posterior fossa decompression and reconstruction in Chiari malformation. Methods Clinical data of 70 patients with Chiari malformation were analyzed retrospectively. Decompression of the posterior fossa was performed, the herniated tonsil of the cerebellum was excised and artificial dura mater suturing was performed without tension. The bone flap was expanded and put back. Results The symptoms and signs disappeared or improved in 68 patients （97.1%） and unchanged in 2 post-surgery. Fifty-nine patients were followed-up from 1 month to 3.5 years, mean 1 year. The signs and symptoms disappeared or improved in 53, unchanged in 4 and deteriorated in 2, the efficient rate was 96.6%. There was 54 patients complicated by syringomyelia and the syringomyelia shrank or disappeared in 52 （96.3%）, unchanged in 1 and expanded in 1. Conclusions Decompression and microsurgery reconstruction of the posterior fossa focuses on relief from oppression of the foramen magnum and reconstruction of cerebrospinal fluid flow dynamics, and is an effective treatment for Chiari malformation.