Chiari畸形并脊髓空洞症的外科治疗

目的:对Chiari畸形并脊髓空洞症(SM)的手术治疗方法进行探讨,并初步评价其治疗效果.方法:对42 例Chiari畸形病例(合并SM 29例)根据其MRI影像,分为Ⅰ型36例和Ⅱ型6例,选择不同手术方式进行治疗:24例ACM-Ⅰ型无或合并轻度SM者行后颅窝减压术,12例ACM-Ⅰ型合并SM达C2以上者行后颅窝减压并脊髓空洞切开分流术,6例ACM-Ⅱ型合并远隔节段SM者行后颅窝减压并小脑扁桃体切除术.结果:患者术后临床症状均有不同程度改善.36例获随访1～4年,其中30例(83.3％)小脑扁桃体下疝得以回纳,25例(86.2％)空洞明显缩小或消失.结论:对Chiari畸形并SM病例依据其影像学分型采取不同的手术方式,疗效满意;手术能使延颈髓充分减压,有效缓解临床症状,并对SM有明显的治疗作用.

Diagnosis and treatment of Chiari's malformation associated with syringomyelia

Objective: To evaluate the diagnosis and treatment of Chiari's malformations with or without syringomyelia. Methods: Forty two cases of Chiari's malformations were classified according to MRI features and received corresponding operation, among which simple posterior fossa decompression was performed on 24 cases, posterior fossa decompression with fluid diversion on 12 cases, posterior fossa decompression with resection of cerebellar tonsils on 6 cases. Results: Thirty six cases were followed up for 1 to 4 years, the cerebellar tonsils returned to original position in 30 cases, and the syringomyelia lumen shrank or even disappeared in 25 cases. Conclusion: Surgical modalities should be chosen according to the types of the Chiari's malformations, the results of the surgical treatment is satisfactory, it can fully decompress the medulla oblongata and relieve the clinical symptoms, and is effective in the treatment of syringomyelia.