两种不同术式治疗Chiari畸形合并脊髓空洞症的疗效分析

Two different surgical therapies in the treatment of Chiari malformation complicated with syringomyelia

目的通过回顾性比较后颅窝成形术及枕大池成形术对Chiari畸形合并脊髓空洞症的治疗，明确两种不同术式治疗Chiari畸形合并脊髓空洞的疗效。方法对收治的85例Chiari畸形合并空洞患者，其中39例患者行后颅窝成形术（后颅窝减压＋硬脑膜成形）；46例患者行枕大池成形术（后颅窝减压＋硬脑膜成形＋小脑扁桃体切除＋蛛网膜粘连分解）。结果两组远期疗效相比有统计学意义，症状改善率分别为64％和90％，恶化19％和3％；术后脊髓卒洞长度改变，两组比较有统计学意义。结论枕大池成形术是治疗Chiari畸形合并脊髓空洞症较为合钾的术式，疗效优于后颅窝成形术。

Objective To evaluate and compare retrospectively the efficacy between posterior cranial fossa plastic repair and cistema magna plastic repair in the treatment of Chiari malformation complicated with syringomyelia. Methods 85 patients suffered from Chiari maltbrmation complicated with syringomyelia were treated in our department from November 2000 to January 2006. 39 patents received posterior cranial fossa plastic repair （ the decompression of posterior cranial fossa and dura plastic repair） , the other 46 patients with cisterna magna plastic repair （ the decompression of posterior cranial fossa, duraplastic repair, resection of hernia below cerebellar tonsil and separation of adherence of arachnoid membrane）. Results There were significant differences between two groups in postoperative syringomyelia length and long-term effects, with the rate of improvement of 64% and 90%, and the rate of deterioration 19% and 3%, respectively. Conclusion Cisterna magna plastic repair is a reasonable option for the treatment of Chiari malformation with syringomyelia, compared with posterior cranial fossa plastic repair.