以脑脊液动力学分析为依据微创减压治疗Chiari畸形Ⅰ型

Minimally invasive decompression for Chiari Ⅰ malformation based on cerebrospinal fluid dynamics analysis

目的探讨基于脑脊液动力学分析的微创软脑膜下减压在Chiari畸形Ⅰ型手术治疗的应用。方法回顾性分析46例Chiari畸形Ⅰ型病人的临床资料,均采用小骨窗颅后窝减压,软脑膜下切除下疝小脑扁桃体,硬脑膜原位缝合。结果术后症状消失或改善45例,无变化1例,无症状加重、死亡病例。42例合并脊髓空洞病人中,复查MRI显示空洞直径缩小40例,无明显变化2例。术后并发症:发热10例,头痛16例,皮下积液2例。术后随访6~48个月,症状消失或改善45例,病情稳定1例,无神经功能恶化病例,有效率97.8%;42例合并脊髓空洞病人中,MRI显示空洞直径缩小或消失41例,无明显变化1例。结论基于脑脊液动力学分析的微创软脑膜下减压可有效解除枕大孔区压迫,重建脑脊液流体动力学循环是治疗Chiari畸形Ⅰ型的有效方法。

Objective To explore the application of minimally invasive subpial decompression based on cerebrospinal fluid dynamics in surgical treatment of Chiari Ⅰ malformation. Methods Clinical data of 46 patients with Chiari Ⅰ malformation were analyzed retrospectively. The posterior fossa decompression with small bone window was performed in all the patients, and the herniated tonsil was resected through subpial surgery, finally, the dura was closed without duraplasty. Results Postoperative symptoms disappeared or improved in 45 patients, remained unchanged in 1 and no disease aggravated or patient died. Among 42 patients with syringomyelia,the cavity diameter reduction or disappeared in 40 and unchanged in 2 based on the MRI reexamination. The postoperative complications included fever in 10 patients, headache in 16 and subcutaneous hydrop in 2. During a follow-up period of 6 to 48 months, the symptoms disappeared or improved in 45 patients, unchanged in 1 and no neurological deterioration occurred. The efficacy rate was 97.8%. Among 42 patients with syringomyelia, the cavity diameter reduction or disapperaed in 41 patients and unchanged in 1 based on the MRI reexamination. Conclusion Minimally invasive subpial decompression based on cerebrospinal fluid dynamics analysis can effectively relieve the compression of the occipital foramen area and reconstruct the cerebrospinal fluid dynamic cycle,thus being an effective method for the treatment of Chiari Ⅰ malformation.