小脑扁桃体切除联合后颅窝重建术治疗合并脊髓空洞症的Chiari—I畸形患者

目的 探讨手术切除下疝的小脑扁桃体及后颅窝苇建术治疗合并脊髓空洞症的Chiari-I畸形患者的疗效.方法 采用显微神经外科手术将下疝的小脑扁桃体切除联合后颅窝重建术治疗37例合并脊髓空洞症的Chiari-I畸形患者.手术中先行后颅窝充分减压,咬除部分枕骨鳞部、枕大孔后缘和寰椎后弓;在保持软膜完整的前提下将下疝至颈椎管内的小脑扁桃体作软膜下吸除;再将四脑室正中孔处的粘连松解,并将脊髓中央管开口处的隔膜剪开;最后用人工硬膜修补材料减张缝合硬膜.结果 术后随访1~3个月,32例患者的神经症状明显好转,4例患者临床症状改善不明显,1例患者临床症状加重.手术后定期复查头颅MRI,6个月后有11例脊髓空洞完全消失,22例脊髓空洞较术前明显缩小,4例脊髓空洞较术前无变化.结论 利用显微神经手术在软膜下切除下疝的小脑扁桃体及后颅窝重建术是治疗合并脊髓空洞症的Chiari-I畸形的一种有效、安全、创伤小的方法.

Tonsillectomy combined with posterior fossa reconstruction in the treatment of Chiari-I malformation associated with syringomyelia

Objective To explore the method and effect of tonsillectomy of tonsillar herniation combined with posterior fossa reconstruction in the treatment of Chiari- [ malformation associated with syringomyelia. Methods A total of 37 patients suffered from Chiari- I malformation associated with syringomyelia underwent tonsillectomy plus posterior fossa reconstruction in our department. Posterior fossa decompression was adopted, then exposed portion of the squama occipital, posterior edge of the foramen magnum, posterior arcus of atlantis, after that subpially resected the cerebelllar tonsils that herniated into the canales with pia mater left intact, subsequently peeled off and separated conglutination of the midian aperture of fourth ventricle, dissected the dissepiment in central canal, and finally an artificial dura patch was used for dura repairment. Results One to 3 months after operation, neurological symptoms of 32 cases showed a remarkable improvement postoperatively. Four cases showed no improvement, 1 case showed symptoms increased. The cranial MRI results were re-examined periodically, syringomyelia of 11 cases disappeared, 22 cases turned to be narrowed considerably, 4 cases showed no changes 6 months after operation. Conclusion Microsurgical technique by resecting herniation of the cerebelllar tonsils subpially plus reconstruction of posterior fossa is an safe, effective and miniinvansive method in the treatment of Chiari- I malformation associated with syringomyelia.