ChiariⅠ型畸形合并脊髓空洞症的外科治疗(附35例报告)

Report of surgical treatment for Chiari malformation type Ⅰ with syringomyelia (35 cases)

目的探讨ChiariⅠ型畸形合并脊髓空洞症的外科治疗方法和疗效。方法回顾性分析35例ChiariⅠ型畸形合并脊髓空洞症患者的临床资料(排除合并寰枢椎脱位和/或齿状突型颅底凹陷者)。所有患者均行"有限的后颅窝减压+小脑扁桃体切除+枕大池成形术"。结果按Tator标准,出院时优30例,良5例;随访32例患者,随访时间6个月～6年,其中优23例,良7例,差2例;空洞缩小21例,消失7例。结论"有限的后颅窝减压+小脑扁桃体切除+枕大池成形术"是目前治疗ChiariⅠ型畸形合并脊髓空洞症的主要手术方式之一,并且治疗效果比较令人满意。但不适合于合并寰枢椎脱位和/或齿状突型颅底凹陷者。

To investigate the surgical treatment for Chiari malformation type Ⅰ（CMI） with syringomyelia and its efficacy.【Methods】The clinical data of 35 patients with CMI with syringomyelia were analyzed retrospectively.The patients who had CMI with atlantoaxial dislocation and/or cranial basilar invagination referred to dens of axis were eliminated.All patients received limited posterior fossa decompression plus removal of herniated cerebellar tonsil plus plastic repairment of cisterna magna.【Results】According to Tator＇s standard,when 35 patients were discharged from our hospital,the curative effect was excellent in 30,good in 5.A total of 32 patients were followed up for a period from 6 months to 6 years.Of these patients,the curative effect was excellent in 23,good in 7 and bad in 2.The cavity in spinal cord reduced in 21,disappeared in 7.【Conclusions】At present,it is one of the main operative procedures treating CMI with syringomyelia to use the limited posterior fossa decompression plus removal of herniated cerebellar tonsil plus plastic repairment of cisterna magna,and the effect of this operative procedure is satisfactory.However,this operative procedure is not suitable for the patients who have CMI with atlantoaxial dislocation and/or cranial basilar invagination referred to dens of axis.