术中超声监测脑脊液流动在ChiariⅠ畸形矫正术中的应用

Monitoring of cerebrospinal fluid flow by intraoperative ultrasound in patients with Chiari Ⅰ malformation

目的评价术中多普勒超声监测脑脊液流动在ChiariⅠ畸形矫正术中的应用。方法对20例ChiariⅠ型患者行术中超声检查,在手术过程中实时监测脑脊液流动及其流动速度。结果20例患者彩色多普勒超声均可实时监测到脑脊液的流动。颅骨减压术后,19例患者脑脊液呈低速流动或消失,进一步行硬膜成形术后脑脊液呈双方向流动,即收缩期由头侧向足侧流动,舒张期反之;最大流速为4～13cm/s,并可见随呼吸节律的变化。1例患者在颅骨减压术后即出现上述典型脑脊液流动频谱,超声提示减压充分,未再进行硬膜成形术;余患者在超声显示脑脊液双向流动后结束手术,除1例症状无明显改善外,其他患者症状明显减轻。结论术中彩色多普勒超声可实时监测ChiariⅠ畸形患者脑脊液流动,并可提示脑脊液循环流动的恢复,客观评价手术效果。

Objective To investigate the feasibility of intraoperative ultrasound （IOUS） for imaging the flow of cerebrospinal fluid （CSF） in Chiari type-I malformation. Methods Twenty Chiari I type patients were scanned by IOUS with color Doppler flow imaging（CDFI） . The CSF flow and the velocity were monitored at different time during steps of operation. Results The flow of CSF was dectected in all 20 cases by real-time IOUS-CDFI. The CSF flow was very slow or indistinct just ＇after bony decompression （ cranieetomy ＋ laminecto- my） in 19 patients, but bi-dlrectional, caudal-directed in systolic phase and cranial-directed in diastolic phase were more vigorous with a peak flow rate of 4-13 cm/s after duralplasty. The waveform exhibited respiratory variations. Only 1 patient showed typical CSF flow as mentioned after craniectomy which meant enough decompression without further duralplasty. All operations were ended after IOUS-CDFI demonstrating bi-directional flow of CSF. The patients were relieved clearly excluding one patient without significant improvement in symptoms. Conclusions IOUS-CDFI can monitor the CSF flow during posterior fossa decompression which provide information about re-circulation flow of CSF and competently evaluate the effectiveness of the surgery.