小范围后颅窝减压治疗Chiari畸形合并脊髓空洞症(附97例报告)

Small range posterior fossa decompression for Chiari malformation with syringomyelia

目的评价以更小的创伤治疗Chiari畸形合并脊髓空洞症的临床疗效。方法小范围后颅窝骨性减压窗范围一般在3 cm×3 cm以内,不切除C_1后弓,切除下疝的小脑扁桃体,松解脊髓中央管开口隔膜,疏通第四脑室脑脊液各输出道,使脑脊液循环通畅。结果 37例术后12 d内MRI示下疝的小脑扁桃体下缘上升到枕骨大孔水平以上。长期随访48例,29例患者症状逐渐改善;14例症状稳定未加重;5例较术前加重,但MRI示脊髓空洞缩小。结论小范围后颅窝减压术能够改善Chiari畸形合并脊髓空洞患者的临床症状,可作为外科治疗Chiari畸形合并脊髓空洞症的一种术式。

Objective To explore the surgical treatment of the Chiari malformation associated with syringomyelia by a minimally invasive procedure. Methods The window of posterior fossa cranieetomy is usually about 3 cm ×3cm or less without removal of C1 posterior arch. The herniated cerebellar tonsil was resected to communicate the fourth ventricle and restore the CSF circulation. Results MRI review at 12th days after operation showed the cerebellar tonsil was above the level of foramen magnum. Of 48 cases , long term follow-up revealed that symptoms improved in 29 cases, 14 cases stable in, deteriorated in 5 cases. MRI showed the syrinx became narrowed in all. Conclusion Small range posterior fossa decompression is good choice for Chiari malformation with syringomyelia.