微骨窗减压篷式硬脑膜重建在Chiari畸形手术的应用

Application of mini-bone window decompression and tent-dural reconstruction in the surgical treatment of Chiari malformation

目的探讨微骨窗减压并硬脑膜篷式重建在Chiari畸形中治疗的临床效果。方法回顾性分析经手术治疗的18例Chiari畸形Ⅰ型病人的临床资料,枕骨大孔区颅骨开窗直径2 cm,寰椎后弓切除1.5 cm,硬脑膜切开并篷式重建。结果术后无明显并发症发生,术前症状明显缓解。术后MRI示:小脑扁桃体上移复位,脊髓空洞明显萎缩。随访6~12个月,按照Tator标准,症状明显改善17例,部分改善1例。结论微骨窗减压并硬脑膜篷式重建术可达到充分减压,减少手术创伤,同时有效避免手术并发症的目的,手术效果满意。

Objective To explore the clinical efficacy of mini-bone window and tent-dural reconstraction in the treatment of Chiari malformation. Methods Clinical data of 18 patients with type I Chiari malformation were analyzed retrospectively. A bone window was prepared in the foramen magnum area for 2 cm in diameter. The posterior arch of the atlas was resected for 1.5 cm in length. The dura mater was cut open and reconstructed in tent-dural type. Results There were no obvious complications after surgery and the preoperative symptoms were significantly relieved. The postoperative MRI showed that the cerebellar tonsils were moved up and reset,and the syringomyelias were obviously atrophied. The patients were followed up for 6 to 12 months, the symptoms were obviously improved in 17 patients and partially improved in 1 according to Tator criteria. Conclusion The mini-bone window decompression and tent-dural reconstruction can achieve complete decompression, reduce surgical trauma, avoid the surgical complications effectively, and obtain the satisfactory therapeutic effects.