CHIARI畸形伴脊髓空洞症的脑脊液动力学

THE STUDY OF CEREBROSPINAL FLUID DYNAMICS IN CHIARI MALFORMATION WITH SYRINGOMYELIA

目的探讨脑脊液动力学在Ｃｈｉａｒｉ畸形伴脊髓空洞症的发生、发展中的作用，提出本病脑脊液动力学异常的早期指标及相应的手术治疗方法。方法全组２２例病人经ＭＲＩ和ＣＴ检查，伴脑积水者进行颅内压监护，其他患者行颈部不同体位的术前和术后的脑脊液动力学研究，按其异常程度分别行脑室腹腔分流术、后颅＋颈１－２椎板减压术和硬膜减张。结果全部病人均有不同程度的脑脊液动力学的改善，术后１６例获得随访，其中１２例复查ＭＲＩ，空洞缩小９例，３例同术前。３例临床症状完全缓解，９例有不同程度改善，２例同术前，２例加重。结论脑脊液动力学的异常在Ｃｈｉａｒｉ畸形伴脊髓空洞症的发病和病程演变中有重要意义，而纠正其异常应是手术治疗的主要目的。合并颅内压增高者，脑室腹腔分流术同样可使空洞缩小。

PURPOSE To elucidate the effect of cerebrospinal fluid dynamics on the pathogenesis and development of Chiari malformation with syringomyelia, and to study the early features of the abnormal cerebrospinal fluid dynamics to made a proper treatment program. METHODS MRI and CT examination were performed in 22 cases with CMS. Patients accompanied with hydrocephalus were under monitoring of intracranial pressure. Pre-and postoperatively the Queckenstedt test under different cervical position was done to study the cerebrospinal fluid dynamics in other patient. According to the results, a series of surgery were selected (VP shunt in 6 cases, suboccipital decompression and laminectomy of C1-2 in 16 cases). RESULTS The cerebrospinal fluid dynamics were improved in all the patients sixteen cases were followed up. Symptoms disappeared in 3 cases, and were improved in 9, unchanged in 2, and worsen in 2. CONCLUSIONS The effect of cerebrospinal fluid dynamics is very important in the pathogenesis and development of Chiari malformation with syringomyelia. The main aim of the surgical treatment is to correct the abnormal cerebrospinal fluid dynamics. For the patient accompanied by high intracranial pressure, VP shunt is also effective.