Arnold-Chiari畸形Ⅰ型并脊髓空洞症的显微外科治疗

Microsurgical treatment of Arnold-Chiari I malformation combined with syringomyelia

目的探讨Arnold-Chiari畸形Ⅰ型并脊髓空洞症的手术方式及术后疗效。方法泸州医学院附属医院神经外科自1997年1月至2010年6月采用不同手术方式治疗Arnold—Chiari畸形Ⅰ型并脊髓空洞症患者185例，回顾性分析其临床资料，总结手术方式及疗效。结果出院时患者症状消失或改善156例，无变化29例，无症状恶化和死亡病例。随访147例患者，症状消失或改善110例，症状无变化26例，症状恶化11例：95例行MRI复查，其中枕大池解剖成形者82例，脊髓空洞明显缩小79例。结论后颅窝减压＋硬膜成形术、小脑扁桃体切除＋枕大池成形术是治疗Arnold-Chiari畸形Ⅰ型并脊髓空洞症有效、合理的手术方式。

Objective To investigate the methods ofmicrosurgical treatment ofArnold-Chiari I malformation combined with syringomyelia and their curative effects. Methods The clinical data of 185 patients with Arnold-Chiari I malformation combined with syringomyelia, admitted to our hospital from January 1997 to June 2010 and received different surgical treatments, were summarized. The relationship between curative effects and operative methods were analyzed. Results When these 185 patients were discharged from our hospital, the clinical signs and symptoms eliminated in 156 （84.3%） and not changed in 29; no symptomatic deterioration and death were noted. One hundred and forty-seven patients were followed up for 3 months-12 years; symptoms disappeared or alleviated in 1 l0 （74.8%）, not changed in 26 and deteriorated in 11. The MR findings in 95 patients demonstrated that the cisternals reconstructed and expanded in 82 and the cavities in spinal cords reduced in 79. Conclusion Both posterior fossa decompression ＋ duraplasty and removal of cerebella tonsils ＋ plastic operation of cistern magna are effective and advisable methods in the treatment of Amold-Chiari I malformation combined with syringomyelia.