颅底陷入症合并小脑扁桃体下疝畸形的联合手术治疗(附4例报告)

Combined operation to treat the basilar invagination complicated with chiari malformation (a report of 4 cases)

目的探讨颅底陷入症(BasilarinvaginationBI)合并小脑扁桃体下疝畸形(Chiarimalformation)的手术治疗方法。方法对4例颅底陷入症合并小脑扁桃体下疝畸形病人经CT、MRI检查并测量Klaus高度指数、齿状突尖到桥延交界处的距离、小脑扁桃体下疝深度,所有病人均首先行后路减压、枕颈钛板固定、植骨融合,然后再行经口咽齿突磨除术。结果所有病人均于术后短期内症状缓解,术后半年4名病人均能生活自理;术后1年2名病人已能参与一般的体育活动,另2名病人也能进行较轻的劳动。结论对颅底陷入症合并小脑扁桃体下疝畸形的病人先行后路减压加固定、植骨融合,再行前路经口咽入路磨除齿突的联合手术,是一种有效的治疗方法,值得进一步应用研究。

Objective To investigate the treatment of basilar invagination complicated with the Chiari malformation. Methods The principal clinical characteristic was observed and radiological features were measured including the Klaus high index, the distance between odontoid tip to-PM (pontomedullary junction), and the depth of cerebellar tonsil herniation in 4 cases of basilar invaginatio complicated with Chiari malformation. All cases were first treated by posterior fossa decompression and resection of cerebellar tonsils then by occipito-cervical fusion followed by treatment of odontoidectomy via oral approach. Results Four patients were improved postoperatively. After 6 months, 4 patients limb myodynamics were recovered normally. Conclusion For patients with Basilar Invagination (BI) complicated with Chiari Malformation, the treatment process is save and reliable. That was first treated by posterior fossa decompression and resection of the cerebellar tonsils then by occipito-cervical fusion followed by the treatment of odontoidectomy via oral approach.