寰枕部骨与膜双减压整复治疗ChiariⅠ畸形的研究

Study of occipital bone and membrane decompression for the treatment of Chiari malformation typeⅠ

目的分析寰枕部骨、膜双减压整复治疗ChiariⅠ畸形的临床疗效。方法对郑州大学人民医院神经外科2016-06—2018-06收治的56例ChiariⅠ畸形患者进行回顾性分析,所有患者采用寰枕部骨、膜双减压整复手术,采用Tator评价标准作为术后疗效评估指标,术后复查MRI检测颅颈交界区解剖变化,应用术中超声辅助检测硬膜内层脑脊液流速作为预后指标。结果56例患者术后MRI显示枕大池重建满意,小脑扁桃体上移复位,脊髓空洞缩小。术中5例患者超声提示脑脊液流速<3 cm/s,术后近期效果稳定,随访1 a后3例症状改善显著,2例症状改善一般,脑脊液流速≥3 cm/s,术后症状缓解时间明显缩短。所有患者末次随访依据Tator评价标准提示,优54例,良2例。结论寰枕部骨、膜双减压整复治疗ChiariⅠ畸形通过纠正后颅窝解剖狭小畸形,恢复解剖结构,改善脑脊液循环途径,是治疗ChiariⅠ型畸形的一种临床有效、可靠的新型手术方案。术中超声可作为判断预后的一种检测方法。

Objective To investigate the clinical efficacy of the treatment of Chiari malformation typeⅠwith occipital and membranous double decompression.Methods Retrospective observation of 56 patients with Chiari malformation typeⅠin Henan Provincial People's Neurosurgery from June 2016 to June 2018.All patients underwent occipital occipital bone and membrane decompression,and intraoperative ultrasound-assisted detection of cerebrospinal fluid flow velocity in the dural layer was used as a prognostic indicator.MRI was performed to understand the anatomical changes of the cranial-cervical junction area,and the Tator evaluation criteria were used.Post-evaluation of efficacy.Results Fifty-six patients underwent MRI with satisfactory reconstruction of the occipital pool.The cerebellar tonsils were moved up and the syringomyelia was reduced.Five patients underwent ultrasound to indicate cerebrospinal fluid flow rate<3 cm/s.The short-term effect was stable after operation.After 1 year of follow-up,3 cases showed significant improvement in symptoms,2 cases improved in general,cerebrospinal fluid flow rate≥3 cm/s,and the postoperative symptom relief time was obvious.shorten.The final follow-up of all patients was based on the Tator evaluation criteriaexcellent in 54 cases,good in 2 cases.Conclusion The treatment of Chiari malformation typeⅠby occipital occipital bone and membrane decompression is a clinically effective and reliable new type of surgery for correcting Chiari malformation typeⅠby correcting the posterior cranial fossa anatomical narrow deformity,restoring anatomical structure and improving cerebrospinal fluid circulation.Intraoperative ultrasound can be used as a detection method to judge the prognosis.