小脑扁桃体切除并脊髓中央管口松解术治疗合并脊髓空洞的Chiari畸形

目的探索外科治疗合并脊髓空洞的Chiari畸形的新方法。方法采用切除下疝小脑扁桃体,并脊髓中央管口假膜切开术,原位硬膜缝合法。结果18例手术治疗,15岁以下儿童12例,术中发现均有脊髓中央管口(闩部)假膜;成人6例,3例有假膜形成。全部病例术后脊髓空洞消失或明显缩小。结论脊髓中央管口假膜是造成Chiari畸形脊髓空洞的原因之一,切除下疝小脑扁桃体并脊髓中央管口假膜切开术,是手术治疗合并脊髓空洞的Chiari畸形最根本的方法。

Chiari malformation with syringomyelia:surgical treatment with tonsillectomy plus central canal opening

Objective A new surgical treatment was used for Chiari malformation with syringomyelia. Methods After opening of the dura, the cerebellar tonsils were removed. We can find a very thin membrane over the opening of the central canal (obex). This pseduomembrane should be cut. Results 18 patients with Chiari malformation with syringomyelia were operated on using this techniques. This kind of pseduomembrane was found in all 12 pediatric cases (below 15 years) and 3 out of 6 in adult patients. MRI confirmed that the syringomyelia disappeared or shrank within 1 months postoperatively in all cases. Conclusions The pseduomembrane at over the obex is one of the reason of Chiari malformation with syringomyelia. The tonsillectomy, the cutting of the pseduomembrane and the dura closing are the ideal treatment for Chiari malformation with syringomyelia.