Arnold-Chiari畸形合并脊髓空洞症的外科治疗

目的：寻求Arnold—Chiari畸形合并脊髓空洞症的病因、发病机制和确实合适的手术方案及术式。方法：通过回顾性分析天津医科大学总医院神经外科在1990年至2003年间收治的143例病例，对比不同手术方式术前术后MRI和临床症状的变化，寻找其间的规律。结果：术前MRI显示，有空洞者比单纯小脑扁桃体下疝者后颅窝更加紧密。术后症状均缓解，MRI显示空洞均减小，但后颅窝减压术者可见小脑扁桃体回缩，而脊髓空洞一腹腔分流术者小脑扁桃体回缩不明显。结论：Arnold—Chiari畸形合并脊髓空洞症是多因素引起的疾病，不能以单一因素来解释。脊髓蛛网膜下腔，特别是颅颈结合部的脑脊液循环障碍，是各种病因的共同点。因此，解除脑脊液循环障碍是治疗这种疾病的关键环节和最终目的。

The surgical treatment of Arnold-Chiari malformation associated with syringomyelia

Purpase:The purpose of the present study is to search the pathogenesis and suitable operation method.Methods:Find the rules through reviewing and analysising of 143 patients treated in neurosurgical department of Tianjin Medical university General Hospital from 1990 to 2003 and comparing the changes of clinical symptoms and MRI pre- and post-operation.Results:Pre-operative MRI showed us that the post fossa of patients with syringomyelia are tighter than those without syringomyelia.After operation the clinical symptoms relieve and MRI showed syringomyelia collapse.Tonsillar herniation drawed back among patients had been done post fossa decompression did not among those had been done syringoperitoneal shunt.Conclusion: Arnold-Chiari malformation associated with syringomyelia is a multifactorial disease,it can not explained by any single factor.The obstruction of the natural CSF circulation in the subarachnoid spaces of the craniocervical junction is a common factor.So,to release the obstruction of CSF is the crux and goal of treatment.