自体骨瓣后颅窝扩大成形治疗Chiari Ⅰ型畸形(附9例临床分析)

Expansive posterior fossa eranioplnsty with occipital flip for arnold-chiari Ⅰ malforma-tion

目的探讨利用自体骨瓣进行后颅窝扩大成形术治疗Chiari I型畸形的临床效果。方法本组9例Chiari I型患者均采用手术治疗,行后颅窝自体骨骨瓣扩大成形、硬脑膜成形、小脑扁桃体切除及粘连蛛网膜分解术。结果 9例患者术后均复查MRI示小脑扁桃体下缘均上升到枕骨大孔水平以上,后颅窝容积增大。8例症状改善明显,1例改善不明显。随访3～18个月,所有病例症状体征较术前改善。MRI示7例合并脊髓空洞患者中,2例空洞消失,5例脊髓空洞明显缩小。结论自体骨瓣后颅窝扩大成形治疗Chiari I畸形患者,临床症状改善,效果满意。

Objective To explore the treatment of expansive posterior fossa cranioplasty with occipital flips for Arnold--chiari I malformation. Methods Methods 9 cases of the patients with Arnold--chiari I malformation all use surgical treatment, do the decompression of posterior cranial fossa,duraplastic repair, resection of hernia below cerebellar tonsil and separation of ad- herence of arachnoid membrane. Results Postoperative MRI studies revealed that cerebellar ton- sillar lower edge of the cases are rising to the foramen magnum level above, the posterior fossa volume increase,8 cases symptoms improved significantly, 1 cases no improvement. Follow-up of 3-18 months, all patients got good clinical outcomes with symptoms relief. MRI showed sy- ringomyelia disappeared in 2cases, significantly thinned in 5 cases, no improvem. Conclusion Conclusion Expansive posterior fossa cranioplasty using occipital flip is effective for arnold chiari I malformation.