枕下减压和硬膜成形术治疗Chiari畸形I型

目的:探讨枕下减压和硬膜成形术治疗Chiari畸形I型的疗效以及手术技巧.方法:采用常规后正中入路、枕骨游离骨瓣、枕大孔区减压(包括C1后弓)、硬膜扩大成形术,治疗Chiari畸形I型患者44例;术后通过临床表现改善情况评价早期(术后1周)疗效,依据Karnofysky评分标准评价后期(术后6个月)疗效.结果:术后早期神经功能改善30例(68%).38例获得随访,平均随访17个月,随访期间神经功能改善率为89%(34/38),Karnofysky评分平均提高5分;稳定4例(11%);无神经功能恶化者.32例出现空洞的患者中,28例得到MRI随访,其中空洞消失8例(均为颈髓空洞)、较术前缩小的16例、无变化4例.结论:枕下减压+硬膜扩大成形术是治疗Chiari畸形I型的有效方法.

Surgery of the Chiari I Malformation with Suboccipital Decompression and Duraplasty

Objective： To explore the efficacy and surgical technique of suboccipital decompression with duroplasty for treating the Chiari I malformation. Methods：44 patients with Chiari I malformation were retro- spectively analyzed. All the patients underwent posterior fossa decompression and dura enlargement with duro- plasty. The extent of the region of magnum foramen, including the posterior arch of C1, was 4 cm ~3 cm. The evaluation of the outcome was based on the improvement of clinical feature at the early stage （ post - operative one week）, and Karnofysky scale at the late stage （6 months after operation）. The mean follow-up period was 17 months in 38 cases. Results：At early stage, the symptoms and signs improved in 30 cases （68%）. 38 cases were followed up （from 6 months to 5 years, average of 17months）. During the follow-up period, postoperative neurological improvement in 34 cases （89% , 34/38 ） , Karnofyski scale improved 5 scores on average. The other 4 cases were stable. The MRI findings demonstrated that the cavities in spinal cords disappeared in 8 cases, reduced in 16 cases. Conclusions ：The effectiveness of posterior fossa decompression with duroplasty as a procedure benefits most patients with Chiari I malformations.