超声吸引刀在Chiari畸形Ⅰ型手术中的应用

Application of cavitron ultrasonic surgical aspirator in Chiari malformation type Ⅰ

目的探讨Chiari畸形Ⅰ型手术中使用超声吸引刀(CUSA)切除小脑扁桃体的效果。方法回顾性分析第四军医大学唐都医院神经外科2015年8月—2017年12月,使用CUSA手术治疗20例Chiari畸形Ⅰ型患者的临床资料(其中13例合并脊髓空洞症)。术后随访观察患者症状和影像学表现的改善状况。结果20例患者术后均得到3~21个月的随访,其中6例患者随访1年以上。术后,症状完全改善的患者5例,改善12例,稳定3例,无恶化病例;症状改善率为85%。术后影像学复查示,所有患者的小脑扁桃体均还纳至正常位置;13例合并脊髓空洞症的患者中,空洞显著缩小3例,空洞缩小7例,空洞维持原状3例,无空洞扩大病例;空洞缩小率为76.9%。结论CUSA可有效切除Chiari畸形Ⅰ型的小脑扁桃体;可作为低频电凝的替代技术用于Chiari畸形Ⅰ型手术治疗中。

Objective To investigate the effect of cerebellar tonsillectomy with cavitron ultrasonic surgical aspirator(CUSA)on cerebellar tonsillectomy in Chiari malformation type I(CM-I)operation.Methods The clinical data of 20 patients with CM-I(13 of whom had syringomyelia)who underwent surgery using CUSA in the Department of Neurosurgery,Tangdu Hospital,Fourth Military Medical University between August 2015 and December 2017 were analyzed retrospectively.After surgery,the symptom improvement and imaging data were followed up.Results All the 20 patients were followed up for 3-21 months,and 6 of them were followed up for more than 1 year.Results of postoperative symptom improvement showed complete improvement in 5 cases,improvement in 12,stability in 3,and no deterioration.The symptom improvement rate was 85%.Postoperative image reexamination results showed cerebellar tonsils were returned to normal position in all patients.Among patients with syringomyelia,the cavity was significantly reduced in 3 cases,the cavity was reduced in 7,the cavity remained unchanged in 3 and there was no case of cavity enlargement.The rate of cavity reduction was 76.9%.Conclusion CUSA can effectively resect cerebellar tonsillar herniation and can be used as an alternative technique to low-frequency electrocoagulation in CM-I surgery.