ChiariⅠ型畸形合并脊髓空洞症的显微外科治疗

Microsurgical Treatment of the Chiari Type I Malformation Complicated with Syringomyelia

目的研究ChiariⅠ型畸形合并脊髓空洞症的显微手术治疗方法。方法枕下正中入路,咬开枕骨大孔后缘及寰椎后弓,显微镜下切开硬脑脊膜,软脑膜下切除下疝的小脑扁桃体,重建第四脑室正中孔与两侧小脑延髓外侧池交通、开放脊髓中央管口,修补硬脑脊膜。结果36例手术均顺利完成,术后恢复平稳、无感染,无死亡。病人肌力,温、痛感觉及肌张力均恢复良好。下疝的小脑扁桃体均消失。随访MRI示,6例空洞症消失,脊髓接近正常;30例脊髓空洞腔明显缩小。结论采用显微手术切除下疝的小脑扁桃体,开放脊髓中央管口,恢复枕大池结构和功能,是治疗ChiariⅠ型畸形合并脊髓空洞症的有效方法。

Objective To explore a microsurgical procedure to treat Chiari type Ⅰ malformation complicated with syringomyelia. Methods The microsurgery through the suboccipital approach were performed in 36 patients with Chiari type Ⅰ malformation complicated syringomyelia. The tonsillar hernia was removed subpially. The communication of CSF between the fourth ventricle and subarachnoid space was reconstructed. The pseduomembrane that was a very thin membrane over the opening of the central canal was cut away. The dura mater was repaired. Results All the patients recovered well after the operation. No infection occurred in all the patients. No patient died. All the patients were followed up from 3 months to 5 years. The muscular force and tension and temperature and pain senses were significantly improved in all the patients after the operation. MRI showed that the tonsillar hernia disappeared 1 week after the operation. The spinal syrinx cavity decreased in 30 patients and disappeared in 6 patients. Conclusions The microsurgery by which the removal of tonsillar hernia, the cutting off the pseduomembrane, reconstructing the communication of CSF between the fourth ventricle and subarachnoid space, and recovering the structure and function of cistern magna is an effective method to treat the Chiari type I malformation complicated with syringomyelia.