前后路联合手术治疗颅底陷入症合并小脑扁桃体下疝畸形

目的：探讨颅底陷入症合并小脑扁桃体下疝畸形的手术治疗方法及效果。方法：8例颅底陷入症合并小脑扁桃体下疝畸形患者，术前均有不同程度四肢痉挛性瘫痪及感觉障碍，均行CT、MRI检查并测量有关数值：Klaus高度指数、齿状突尖到脑桥延髓交界处的距离及小脑扁桃体下疝深度。所有患者均首先接受后路减压、枕颈钛板固定、植骨融合，然后再经口咽行齿状突磨除术。结果：术后症状均得到缓解，随访8个月至2年，平均1．5年，术后半年8例患者生活均能自理，术后1年，4例患者能参与一般的体育活动，另4例患者也能进行较轻的劳动。MRI示内固定稳固，延颈髓角度明显增大，脊髓压迫解除，植骨融合。结论：对颅底陷入症合并小脑扁桃体下疝畸形的患者先行后路减压固定、植骨融合，再行前路经口咽人路磨除齿状突的联合手术，安全可靠、效果好。

Combined anterioposteriorly approach to the basilar invagination complicated with the Chiari malformation

Objective:To investigate the surgical treatment of basilar invagination complicated with the Chiari malformation.Method:8 cases with basilar invagination complicated with Chiari malformation were reviewed.The principal clinical characteristics and the radiological index including the Klaus high index,odontoid tip-PM(pontomedullary junction),the depth of cerebellar tonsil herniation of all 8 cases were analysed.All cases underwent posterior fossa decompression and occipito-cervical fusion followed by odontoidectomy via oral approach.Result:8 cases with partial quardroplegia preoperatively recovered to some extent postoperatively after a mean follow-up of 1.5 years(8 months to 24 months),all patients were able to undertake the daily labour,all cases had the MRI evedences of bone fusion,enlarged CM angle and complete decompression.Conclusion:For patients with basilar invagination(BI) complicated with the Chiari malformation,the posterior fossa decompression and occipito-cervical fusion followed by odontoidectomy via oral approach is safe and reliable.