36例体枕大池成形术治疗Chiari畸形合并脊髓空洞症的体会

Reconstruction of the Cistern Magna to Treat Syringomyelia Associated with Chiari Type Ⅰ Malformation

目的研究探讨一种小脑扁桃体切除+枕大池成形术治疗Chiari畸形合并脊髓空洞症的手术治疗方法。方法采用枕下正中入路,咬开枕骨大孔后缘下至下项线,两侧至枕骨大孔4、8点钟位置大小约2.5cm×4.0cm,咬除寰椎后弓,"T"形切开硬脑膜和蛛网膜。软脑膜下切除两侧小脑扁桃体,开放正中孔直至四脑室底并且打通两侧小脑延髓池。取肌筋膜行硬脑脊膜连同蛛网膜的扩大修补,形成新的枕大池。结果本组病例术后两年均得到随访,MRI复查示空洞腔都明显缩小,其中2例空洞消失,感觉恢复较肌力恢复良好。结论此手术方法效果满意。其要点是:①小脑扁桃体在软膜下切除并行软膜缝合。②四脑室正中孔开放并和两侧小脑延髓池相通。③枕骨大孔区蛛网膜下腔扩大修补缝合,无须行后颅窝减压术。

Objective To study a surgical procedure for treating syringomeyelia associated with chiari type Ⅰ by removement of cerebella tonsils and plastic operation of cistern magna.Methods Subocciptal craniotomy and laminectomy of were performed,inferior nuchal linear as the superior edge of bone window,bilateral width was from 4,8 clock position of foramen magnum,the size of bone window was about 2.5×4.0cm.Dura and arachnils were removed subpially and peel off conglutination.The communication of CSF between the fourth ventride and subarachnoid space was achieved,the fassia graft,a new enlarged cistern magna was developed.Results In 10 cases,4 patients were male and 6were female,ranging of age from 22 to 61 gears in all cases were folllwed up two years.Postoperative MRI revealed the size of the syrinx cavity decreased in all cases,the syrinx cavity disappeared in 2 cases.The improvement of symptom of sensation was more significant than that of muscle power.Conclusions The principles of the procedure are：①The cerebellar tonsils must be removed subpially;②The medica formebs of the fourth ventricle had to be opened;③The subarchnoid space next to the foramen must be enlarged and posterior cranial fossa decompression procedure was not necessary.