术中超声在小脑扁桃体下疝畸形颅后窝减压术的应用

Application of intraoperative ultrasonography in posterior fossa decompression for Arnold-Chiari malformation

目的总结术中超声在小脑扁桃体下疝畸形后颅窝减压术中应用及其效果分析。方法回顾性分析22例小脑扁桃体下疝畸形病例资料,术中应用超声辅助进行颅后窝减压术,包括单纯骨性减压术6例,骨性减压并硬膜成形术13例,枕大池重建术3例。结果在术中超声辅助监测下,22例病人均实现脊髓背侧脑脊液流动速率≥3 cm/s。22例病人术后第1天自觉症状得到改善。术后出现颅内感染2例,皮下积液1例,经治疗后病情得以控制并好转。随访3年,22例病人临床症状均明显改善。16例术前含有脊髓空洞的病人,脊髓空洞均减小,其中1例脊髓空洞消失。结论小脑扁桃体下疝畸形根据术中超声可采取单纯骨性减压术、骨性减压并硬膜成形术与枕大池重建术,从而以最小手术风险获得最大收益。

Objective To summarize the application and effect analysis of intraoperative ultrasound in posterior fossa decompression for Arnold-Chiari malformation. Methods The data of 22 patients with Arnold-chiari malformation were analyzed retrospectively.Intraoperative ultrasound-assisted posterior fossa decompression, including simple bone decompression in 6 cases, bone decompression and dural plasty in 13, and cisterna magna reconstruction in 3, was performed. Results In the intraoperative ultrasound, 22 patients achieved dorsal spinal cerebrospinal fluid flow velocity ≥3 cm/s. The symptoms on the first day after surgery were improved in 22 patients. Postoperative complications were intracranial infection in 2 cases and subcutaneous effusion in 1 case. After treatment, the disease condition was controlled and improved. Followed up for 3 years, clinical symptoms of 22 patients were significantly improved.The cavity of syringomyelia was reduced in 16 patients with syringomyelia before surgery and syringomyelia disappeared in 1.Conclusions The Arnold-Chiari malformation can, based on intraoperative ultrasound, achieve maximum benefit with minimal surgical risk by simple bone decompression, bone decompression with dural plasty, or cisterna magna reconstruction.