Chiari畸形Ⅰ型颅颈部蛛网膜下腔改变与外科治疗

Alteration of subarachnoid space in craniocervical junction of Chiari type I malformation and its surgical treatment

目的:研究Chiari畸形I型(CMI)患者颅颈部蛛网膜下腔(SS)形态学改变及其在疾病发生和外科治疗中的意义。方法:通过磁共振成象(MRI)技术观测颅颈部蛛网膜下腔形态学指标,结合临床,对病例组与正常对照组、术前与术后,进行对比分析;手术采用后颅窝减压、枕大池成形术。结果:CMI患者颅颈部既有先天性发育异常,又有后天继发性改变,导致其整个颅颈部SS较对照组显著变窄(前池、侧池、枕大池均明显变窄);术后均有不同程度增宽,术后SS狭窄较术前改善明显者,其临床症状恢复和空洞消退也快而明显。结论:颅颈部SS狭窄导致脑脊液循环障碍在CMI疾病发生发展和转归中起重要作用,外科治疗应以解除颅颈部蛛网膜下腔梗阻为目的,减压一定要充分,重建颅颈部蛛网膜下腔。

Objective：To investigate the alteration of subarachnoid space（SS） in the craniocervical junction（CCJ） region of the patients with Chiari type Ⅰ malformation（CMI） and to study its clinical significance in the pathogenesis and its surgical treatment.Methods：The morphological changes in SS were observed by means of MRI.The posterior cranial fossa was decompressed and cistema magna plasty were adapted.The changes and clinical symptoms of the CMI group and the control group were analyzed before and after the surgical treatment.Results：The patients with CCJ showed inborn maldevelopment,as well as postnatal secondary changes,which led to their whole SS including anterior cistern and cistern magna,was significantly narrower than that of the control group.However,the narrow SS in the CCJ region were improved greatly on the MRI scans after the surgical operation,with a decrease of cavity and clinical improvement.Conclusion：The narrows of SS can cause cerebrospinal fluid circulation disorder in the CCJ region,which plays an important role in the occurrence and development of CMJ and should be improved by surgical operation.The purpose of surgical operation is to reduce sufficiently the pressure and remove the clog in SS.