后颅窝重建手术治疗Chiari畸形合并脊髓空洞症

Operative reconstruction of the posterior fossa to treat Arnold-Chiari malformation associated with syringomyelia

目的探讨后颅窝重建这种手术方法对Chiari畸形合并脊髓空洞症的治疗及其效果。方法枕下正中入路,以枕大孔为中心,在其上和两侧2cm左右范围内去除枕骨鳞部,咬除环椎后弓,剪开硬膜,如需要打开蛛网膜,应尽量保持软脑膜完整。取自体肌筋膜或硬脑膜替代材料扩大修补。结果30例病人,术后症状均有不同程度的改善,术后3个月复查MRI见脊髓空洞缩小。结论手术使颅颈交界区充分减压,改善了脑脊液循环状态,有效地缓解了临床症状,并对脊髓空洞有明显的治疗作用。扩大修补硬脑膜有利于减少术后并发症的发生。

Objective To disscus a surgical procedure of reconstruction of the posterior fossa for the treatment of Chiari malformation associated with syringomyelia, as well as its effectiveness. Methods Suboccipital midline approach was adopted. Craniectomy including the squamous portion of the occipital bone within 2cm range centered by the foramen magnum and removal of the posterior arch of the atlas were performed. The opened dura was closed with a graft of autologous muscular fascia or artificial dura. Results The symptoms improved at different degrees in all 30 cases postoperatively. Three-month follow-up MRI showed a decrease of the syringomyelia. Conclusion Sufficient decompression at the craniocervical junction by the surgical procedure would ameliorate the behavior of the cerebral spinal fluid circulation, and reverse the symptoms and syringomyelia. Enlarged reconstruction of the posterior fossa was also contributed to decrease the postoperative complications.