颅后窝重建治疗小脑扁桃体下疝畸形

Posterior fossa reconstruction for the treatment of ChiariⅠ malformation

目的 :探讨小脑扁桃体下疝畸形 (ChiariⅠ型 )外科手术的新方法。 方法 :采用枕后正中直切口 ,颅后窝小骨窗 (3cm× 4cm)开颅并咬开枕骨大孔 ,视病情轻重咬除C1～C3 后弓及椎板 ,“Y”形切开硬脑膜 ,软脑膜下切除小脑扁桃体并缝合软脑膜切口 ,分离小脑扁桃体与延髓的粘连 ,建立脑脊液循环通路 ,取枕筋膜或人工硬脑膜行硬脑膜扩大修补 ,部分患者行枕骨钛板修补。 结果 :16例患者中 ,10例症状明显改善 ,6例病情稳定。 14例伴有脊髓空洞症的患者术后空洞明显缩小。 结论 :颅后窝小骨窗开颅合并硬脑膜扩大修补术手术创伤小 ,临床效果稳定 ,是一种安全有效的手术方法。

Objective:To explore the new surgical techniques for ChiariⅠ malformation. Method:Sixteen patients with ChiariⅠ malformation operated on during period from 1999 to 2002 were retropectively analysed. All patients undergoing craniovertebral decompression were placed in the prone position.A midline incision extending from inion to the spinous process of C 1 or C 2 was used depending on the extent of cerebellar herniation.The craniectomy was 4cm above the foramen magnum and 3 cm wide.C 1,or occasionally at C 2,laminectomy was done if needed. Y-shaped dural opening was created and the cerebellar tonsils was subpial resected and separated from the brain stem. For expansions of the posterior cranial fossa, the placement of a patulous dural graft of either autologous material or artificial material was performed. Results: Among the 16 cases 10 cases(67%) improved significanly in their clinical symptoms and 6 cases conditions were stabilized. Fourteen patients suffered from syringomyelia had much improvement in image signs. Conclusion: Mini craniectomy and expansile reconstruction of posterior fossa is an effective technique for the treatment of ChiariⅠ malformation .