Chiari畸形并脊髓空洞的治疗与小脑扁桃体下疝分型

Surgical Treatment of Chiari Malformation with Syringomyelia and Typing of Downward Hernia of Cerebellar Tonsil

目的探讨Chiari畸形并脊髓空洞手术中,下疝的小脑扁桃体下舌分型与切除的标准。方法术中显微镜下观察32例下疝的小脑扁桃体压迫延髓的部位及其关系,结合MRI,提出下疝的小脑扁桃体分型,并根据分型切除小脑扁桃体下舌,切开脊髓中央管开口隔膜或活瓣,恢复第四脑室内脑脊液循环通畅。结果小脑扁桃体分型:①根据压迫部位分为:后方型27例,侧方型4例,侧前方型1例;②根据小脑扁桃体下疝程度分为:单侧压迫型11例,双侧压迫型21例。术后随访28例,MRI检查示下疝的小脑扁桃体均消失,第四脑室内脑脊液循环通畅,脊髓空洞明显缩小和消失;术后病人临床症状大多改善。结论下疝的小脑扁桃体根据其分型并切除,可为手术治疗Chiari畸形并脊髓空洞提供标准及依据。。

Objective To explore the surgical treatment of the Chiari malformation with syringomyelia and typing of the downward hernia of cerebellar tonsil （DHCT）. Methods Microsurgery was performed and the DHCT were typed according to the obiongatal region compressed by DHCT, the severity of DHCT, and outcomes of MRI in 32 patients with Chiari malformation accompanied by syringomyelia. According to types of DHCT, DHCT was removed, the dissepiments or movable valves on the opening of the central canals of the spinal cords were incised to make circulation of cerebrospinal fluid free. Results According to the compressed oblongatal regions, 32 cases of DHCT were divided into 3 types, i.e. posterior type （27 cases）, lateral type （4 cases） and anterolateral type （1 cases）. According to the severity of DHCT, 32 cases of DHCT were divided into both the unilateral （11 cases） and bilateral （21 cases） types. All the patients were improved in the clinical symptoms and signs after the surgery. The following-up from 0.5 to 2 years in 28 patients showed that the syringomyelia disappeared or shrank and the eerebrospinal fluid circulation was free on MRI. Conclusion The resection of DHCT according to types of DHCT and the incision of the dissepiment or movable valves may be an ideal method to treat Chiari malformation with syringomyelia.