Arnold-Chiari畸形143例显微手术治疗经验体会

Microsurgical Treatment Experiences and Understandings of 143 Arnold-Chiari Malformations

目的探讨Arnold-Chiari畸形手术治疗方法及治疗经验体会。方法回顾性分析143例Arnold-Chiari畸形患者的临床资料。143例患者均行枕下减压术,其中95例行轻划硬膜减压,48例行自体筋膜扩大重建。全部患者术前均行MRI检查,其中132例伴发脊髓空洞,24例伴有寰枢椎脱位、半脱位,颅底陷入、扁平颅底等寰枕畸形。结果 3例术后死亡,8例脑脊液漏,近期治疗无效5例。117例获得随访,随访3个月~6年,平均随访2.5年,痊愈67例,好转33例,远期治疗无效17例,一期行经口齿状突切除-枕颈内固定者7例,行单纯枢枕植骨融合者4例。结论枕下减压自体筋膜修补扩大重建是目前最为行之有效的方法,对于颅颈交界区的稳定性必须给予充分的重视。

Objective To investigate the microsurgical approach and therapy experiences as well as the understandings of Arnold-Chiari malformation.Methods The clinical data of 143 cases of Chiari malformation were analyzed retrospectively;they were performed by posterior fossa decompression,among whom light-cutting on dura were performed in 95 cases,and others were reconstructed using autologous fascia.MRI showed that 132 cases were accompanied by syringomyelia,24 cases accompanied by other antalo-occipital malformations including atlanto-axial dislocation,subluxation,basilar invagination,platybasia,etc.Results 3 patients died after operation,CSF leakage were found in 8 patients,no recent curative effect were found in 5 cases,117 patients were followed up for 3 months^6 years,67 of whom were fully cured and 33 were improved,17 cases had no long-term curative effect.One-staged internal fixation for occipito-cervical fusions was performed in 7 cases,and 4 cases underwent simple axial-occipital bone grafting fusion.Conclusion To date sub-occipital decompression and autologous fascia reconstruction were effective method and brought favorable outcomes,and the emphasis must be focused on the stabilization of occipito-cervical junction.