枕大池重建术治疗Chiari畸形合并脊髓空洞症

Reconstruction of cistern magna to treat Chiari malformation associated with syringomyelia

目的探讨枕大池重建术治疗Chiari畸形合并脊髓空洞症的操作要点及治疗效果。方法回顾分析我院及南京军区南京总医院2004年1月—2011年12月收治的43例Chiari畸形合并脊髓空洞症患者的临床资料,所有患者均行手术治疗,枕下正中入路,以枕骨大孔为中心,咬除枕骨鳞部及寰椎后弓,"Y"形切开硬脑膜,电灼缩小或部分切除小脑扁桃体,分离粘连开放正中孔,扩大修补硬脑膜。结果 43例患者中40例症状明显改善,2例无明显好转,1例有所加重,术后复查MRI示39例患者脊髓空洞均有不同程度缩小甚至消失,4例无明显缩小,无空洞扩大。结论后颅凹减压、小脑扁桃体部分切除、开放正中孔、扩大硬膜修补能显著改善Chiari畸形合并脊髓空洞症的临床症状,是目前治疗该疾病的有效手术方法。

Objective To study the surgical procedure and treatment effect of reconstruction of cistern magna for the treatment of Chiari malformation associated with syringomyelia. Methods A total of 43 patients diagnosed as Chiari malformation associated with syringomyelia and admitled to our hospital and Nanjing General Hospital of Nanjing command from January 2004 to December 2011 were enrolled into this retrospective analysis. All the patients underwent surgical treatment, i.e. suboccipital eraniotomy and lami- nectomy of Cl segment through center of foramen magnum. The dura mater was opened with Y-shaped incision. The cerebellar ton- sils were reduced or even removed subpially by electroeoagulation. We separated the adhesions and then opened the median aperture of fourth ventricle. A new enlarged cistern magna was developed. Results Symptoms greatly improved in 40, did not significantly improve in 2, and was aggravated in 1 of the 43 patients. Postoperative MRI revealed the size of the syrinx cavity decreased or even disappeared in 39, and did not significant change in 4 ones. The results were satisfactory. Conclusion The microsurglcal proce- dures including enlargement of posterior fossa, tonsillectomy,median aperture opening and expansile dural repair may improve appar- ently the symptoms of Chiari malformation associated with syringomyelia. These surgical techniques are therapeutically effective on the disease.