保留枕骨大孔的颅后窝减压术治疗Ⅰ型小脑扁桃体下疝畸形的疗效

Posterior fossa decompression with preservation of intact occipital foramen for Chiari malformation-Ⅰ

目的探讨探讨保留枕骨大孔的颅后窝减压术治疗Ⅰ型小脑扁桃体下疝畸形(CM-Ⅰ)的疗效。方法回顾性分析2015年1月至2016年5月收治的21例CM-Ⅰ的临床资料。采用枕骨小骨窗减压(骨窗大小约2.5 cm×2.5 cm)及枕大池成形术,并保留枕骨大孔后缘约0.5 cm骨质。术前、术后1周、术后1年采用KPS评分、神经症状改善及小脑扁桃下疝程度评估疗效。结果术后1周KPS评分[(66.52±9.8)分]较术前[(52.9±9.1)]明显增高(P<0.05)。术后1年KPS评分[(84.7±7.2)分]较术后1周明显增高(P<0.05)。术后1年神经症状改善率(90.48%,19/21)较术后1周(71.43%,15/21)明显提高(P<0.05)。术后1年小脑扁桃体下疝程度[超过枕骨大孔(2.9±1.8)mm]较术前[(4.1±1.4)mm]明显缩小(P<0.05)。结论保留枕骨大孔的颅后窝减压+枕大池成形术是治疗CM-Ⅰ安全、有效的方法。

Objective To investigate the clinical effect of the posterior fossa decompression with intact occipital foramen on Chiari malformationⅠ(CM-Ⅰ)without occipital foramen stenosis.Methods The clinical data of 21 CM-Ⅰpatients with syringomyelia,who underwent small bone window posterior fossa decompression and plastic surgery of cistern magna from January,2015 to May,2016,were analyzed retrospectively.The retained posterior margin of the occipital foramen was about 0.5 cm wide.The effects were observed 1 week and 1 year after the operation in all the patients.Results Kamofsky performance status scores[(52.9±9.1)points]were significantly lower before the operation than those[(66.52±9.8)points 1 week after the operation(P<0.05),which were significantly lower than those[(84.7±7.2)points]1 year after the operation(P<0.05).The rates of symptom improvement 1 week and 1 year after the operation were 71.43%(15/21)and 90.48%(19/21)respectively.Conclusion The small bone window decompression and plastic operation of cistern magna with preservation of the posterior margin of the foramen magnum are an effective and safe method to treat CM-Ⅰwithout occipital foramen stenosis.