Chiari畸形寰枕区后部硬膜的变化及组织学观察

Pathological morphology of the dura matter at posterior atlanto-occipital junction in Chiari malformation

目的:观察Chiari畸形患者颅颈交界寰枕区后部硬膜的变化及其组织学特征,探讨局部硬膜增厚在Chiari畸形发病的作用。方法:27例Chiari畸形患者,7例非颅颈交界区病变患者作为对照,均于手术中切取寰枕区后部硬膜外层和寰枕后筋膜,行常规HE染色,在光学显微镜下观察组织学改变。结果:Chiari畸形患者寰枕区后部硬膜外层和寰枕后筋膜明显增厚,HE染色可见纤维形态异常,排列不规则,出现断裂,并呈不连续分布,27例均出现透明变性,17例表现明显的胶原化,9例出现钙化,3例出现骨化等退行性改变;而对照组仅发现3例有轻度透明变性。结论:Chiair畸形患者颅颈交界寰枕区后部硬膜和寰枕后筋膜变性增厚,可能参与加重Chiari畸形的病理生理改变,提示手术中必须充分切开减压。

Objective：To explore the pathological change of dura matter at posterior atlanto-oeeipital junction and in Chiari malformation and its role in pathogenesis.Method：The dura matter tissue at posterior atlantooccipital junction and posterior atlanto-occipilal ficial membrane in 27 patients with Chiari malformation and 7 patients with no craniocervical junction disorders were surgically sampled,which were followed by routine HE staining and organizational structure analysis under microscopy.Result：The posterior atlanto-occipital fieial membrane and outter layer of dura matter were observed thichened and sticked together in Chiari malformation Anormality, disarrangement, disruption and discontinuity distribution of fibrous morphology were evidenced under HE staining,all 27 cases had hyaline degeneration,Kl cases had obvious collagen degeneration,9 cases had calcification and 3 cases had ossification,while only 3 cases in control had mild hyaline degeneration. Conclusion：The thickened dura matter in posterior atlanto-occipital junction combined with sticked posterior atlanto-occipital ficial membrane may be involved in the pathological progression of Chiari malformation.The pathological change aformentioned is indicated for thorough duraplasty and decompression.