蛛网膜外颅颈区有限骨性减压并硬膜修补治疗Chiari畸形Ⅰ型

Extra-arachnoidal limited craniocervical bony decompression with extended duroplasty for ChiariⅠdeformity in adults

目的探讨蛛网膜外颅颈区有限骨性减压并硬膜扩大修补处理成年人Chiari畸形I型的手术效果。方法回顾分析1997年7月-2007年8月收治的成年人Chiari畸形I型患者32例，其中21例合并脊髓空洞，均无颅内感染病史。术中皆未发现蛛网膜黏连，皆行颅颈区有限骨性减压并硬膜扩大修补处理，29例未切开蛛网膜，3例小脑扁桃体下疝严重者行蛛网膜切开，在软膜下吸除小脑扁桃体。结果术后28例得到随访，平均随访4．5年（0．5-10．3年），临床有效23例，稳定5例，无恶化。合并脊髓空洞患者17例术后复查MRI，15例术后空洞消失或减少，2例无变化。术后发生局部皮下积液1例，急性脑积水1例，均发生在蛛网膜切开病例，分别经腰大池引流和短期脑室外引流治愈。结论对无局部蛛网膜黏连的成年人Chiari畸形I型病例，蛛网膜外颅颈区有限骨性减压并硬膜扩大修补手术的长期效果。

Objective To explore the effect of extra-arachnoidal limited craniocervical bony decompression with extended duroplasty （ELBDED） on Chiari I deformity in adults without local adhesive arachnoiditis. Methods Thirty-two adult patients with Chiari I deformity, admitted to our hospital from July 1997 and August 2007, were retrospectively analyzed. Of the 32 patients, 21 were complicated by syringomyelia but had no history of intracranial infection. The patients underwent ELBDED in combination with extended duroplasty. No arachnoid adhesion was found during operation. Arachnoid membrane was intact in 29 patients. Critical herniation of cerebellar tonsil, found in 3 patients, was aspirated through the dura mater. Results Of the 28 patients who were followed up for a mean time of 4.5 years （range 0.5-10.3years）, 23（82.1%） had improvements in neurological disturbances, 5 became stable with no exacerbation of the disease. Seventeen patients with syringomyelia underwent MR imaging. The syrinx became smaller or collapsed in 15 patients, and remained stable in 2 patients. Postoperative complications including subcutaneous hydrocele and acute hydrocephalus occurred in 2 cases, respectively, after the arachnoid was opened. The complications disappeared after lumbar and ventricular drainage. Conclusion Long time good results can be achieved in Chiari I deformity adult patients without local adhesive arachnoiditis with ELBDED.