ChiariⅠ型畸形的MRI表现及其手术治疗

目的 探讨Chiari Ⅰ型畸形的MRI分型及治疗方法。方法 23例Chiari Ⅰ型畸形患E,21例有颈神经根症状,16例表现为中央管周围损害症状,另有8例分别存在小脑及颅神经损害症状。MR检查显示,单纯小脑扁桃体下疝(B型)7例(30.43％),小脑扁桃体下疝合并脊髓空洞症(A型)16例(69.57％)。根据MRI所显示病变部位,采用不同的手术方式,其中11例行后颅窝减压术,7例行后颅窝减压井小脑扁桃体切除术,5例行后颅窝减压并脊髓空洞切开引流术。结果 手术后18例患者(78.26％)症状改善,5例(21.74％)与手术前比较无明显变化。对16例伴脊髓空洞症患者中的13例进行随访,其中3例空洞消失,7例空洞显著缩小,3例空洞较手术前缩小50％。结论 手术治疗可使延髓、颈髓充分减压,有效缓解临床症状,并对脊髓空洞症具有良好的治疗效果。

MRI patterns and surgical treatment of Chiari I malformation

Objective The MRI classification and surgical treatment of Chiari I malformation werestudied. Methods Twenty-three patients with Chiari I malformation were including nerve root disorder (21 cases), pericanal disorders of central canal (16 cases) and cerehellar and cranial nerve disorders (8 cases). The MRI showed that there were eerebellar infratonsillar hernia (B type) 7 cases(30.43%) and infratonsillar hernia complicated with syringomyelia (A type) 16 cases(69.57%). The laminectomy through posterior approach of cervical vertebra was performed based on the lesion location displayed by MRI. Among these patients decompression of posterior cranial fossa (11eases), decompression of posterior cranial fossa and cerebellar tonsillecto-my (7 cases), decompression of posterior cranial fossa and incision and drainage for syringomyelia (5 cases) were performed. Results There were 18 patients (78.26%) with symptom abatement and 5 patients (21.74%) without significant effect after operation. Thirteen patients were followed up in 16 patients with syringomyelia, among them disappear of cavity in 3 cases, significant reduce of cavity size in 7 cases and reduced 50% oi cavity size in 3 cases compared with preoperation were found. Conclusion Surgical treatment may fully decompress the medulla oblongata and cervical cord effectively ameliorate clinical symptoms, and is significantly effective in treatment of syringomyelia.