Chiari畸形手术方法的改良

Improvement of surgical method for Chiari malformation

目的探讨小脑扁桃体下疝畸形(Chiari畸形)的手术方法,提高治疗效果,减少并发症.方法本院自1993年12月至2003年12月对收治的86例Chiari畸形及部分合并脊髓空洞症患者实施了改良的枕大孔区小骨窗骨性减压、局部硬膜外层剥脱术.术后82例得到随访,平均随访5.5年(1～9年),其中50例MRI复查头颈部.结果患者症状明显改善59例,部分改善10例,无变化13例,有效率占随访者84.15%,无手术并发症.结论改良的手术方式,在枕颈交界区骨性减压后,保留枕大孔区内层硬膜结构的情况下,可改善局部蛛网膜下腔脑脊液循环,缓解小脑扁桃体对延颈髓的压迫,效果较显著,同时减少了并发症.

Objective To study the improvement of surgical method for Chiari malformation and better the prognosis and reduce postoperative complications. Methods Bony foramen magnum decompression combined with the detachment of outer layer of dura mater was performed on 86 patients with Chiari malformation (some complicated by syringomyelia) who were admitted from December 1993 to December 2003. Postoperative cerebral MRI scanning was taken for 50 out of 82 cases with follow-up of an average period of 5.5 years (1~9 years). Results Neurological symptoms and signs were remarkably improved in 59 cases, partially in 10 and unchanged in 13, with a total effectiveness being 84.15% of the follow-ups and no postoperative complications. Conclusion Foramen magnum decompression combined with the detachment of outer layer of dura mater is effective and of less complications in the surgical treatment of Chiari malformation with syringomyelia.