Arnold-Chiari畸形的手术治疗--MRI对中远期疗效的评价

目的通过对比不同术式的术后临床及MR影像效果，探讨Arnold-Chiari畸形的最佳手术方案。方法复习1992年至2002年在我院手术治疗的214例Arnold-Chiari畸形病例的临床及MR影像资料、手术记录，通过与术后1a至10a的随访结果相比较，分析各种术式的临床效果与影像学效果。结果MRI所见与临床效果高度一致。临床效果：轻、中度畸形组病例分别采用术式1(后颅窝减压成形术)、术式2(后颅窝减压成形术 小脑扁桃体切除术)的短期、中期、长期有效率均为100％。重度畸形组病例采用术式3(术式2 脊髓空洞一蛛网膜下腔分流术)的短期有效率为92．2％，中期有效率为97．1％，长期有效率为96．4％。影像效果：术式1的中、长期有效率为100％；术式2的中期有效率为100％，长期有效率为94．4％；术式3的中期有效率为95．7％，长期有效率为91．6％。结论对Arnold—Chiari畸形的手术治疗应根据影像显示的畸形程度采取相应的术式。彻底的后颅窝减压是影响疗效的最关键因素。对巨大的广泛性脊髓空洞病例，在后颅窝减压及小脑扁桃体切除的同时行脊髓空洞一蛛网膜下腔分流是安全、有效的治疗手段。术前畸形复杂、严重，年龄大、病程长是效果不佳的主要原因。

Surgical results in patients with Arnold - Chiari malformations——follow - up with MRI

Objective To evaluate the surgical results of different operating technics by the long-term MRI follow-up of a series of patients with Arnold-Chiari malformation. Methods The hospitalized records, operative reports, MR images and follow-up data of 214 patients with Chiari I malformation who were underwent a operation between 1992 and 2002 were retrospectively reviewed. The duration of follow up was from 1 to 10 years. Results Postoperative relief of the lesions on MRI was associated with the relief of symptoms. In the evaluating with symptoms, the medium and long term efficacy of both groups of mild and medium patients treated with posterior fossa decompression and posterior fossa decompression +tonsillectomy was 100 %. In the group of severe patients treated with posterior fossa decompression +tonsillectomy +syrinx-subarachnoid space shunt, the short term efficacy was 92.2 %, the medium term efficacy was 97.1%and the long term efficacy was 96.4 %. In the evaluating with MRI, the medium and the long term efficacy of the group of mild patients was 100 %; the medium term efficacy of the group of medium patients was 100 %, but the long term efficacy was 94.4 %. In the group of severe patients, the medium term efficacy was 95.7 %and long term efficacy was 91.6 %. Conclusion In the treatment of Arnold-Chiari malformations, different operating technics should be taken according to the severity of lesions on MRI. Complete posterior fossa decompression is the key point to the out-come of the patients. For the patients with huge syringomyelia, syrinx-subarachnoid space shunt is an effective technic. Factors which were associated with insufficient postoperative results include the complex malformation, aged patients or too long medical history.