Chiari畸形Ⅰ型并脊髓空洞症术后翻修的疗效观察

摘要

目的 探讨Chiari畸形Ⅰ型并脊髓空洞症患者术后翻修的方法及疗效.方法 2004年5月至2013年4月收治Chiari畸形Ⅰ型并脊髓空洞症术后患者15例,患者均存在原有症状体征无改善或(和)加重,或(和)出现新的神经功能缺失,其中初次手术采用后颅窝大骨窗减压术8例,后颅窝骨窗减压+硬膜外层切开术3例,后颅窝成形术+硬膜扩大修补术2例,下疝小脑扁桃体切除术+枕大池成形术2例.翻修手术均采用下疝小脑扁桃体切除+第四脑室流出道探查术,3例行疏通术.结果 翻修术后随访4 ～ 47个月平均24.1个月,症状基本消失者8例,明显改善者5例,无改善者2例.MRI示小脑扁桃体下缘均达枕骨大孔上方,脊髓空洞均缩小.结论 对Chiari畸形Ⅰ型并脊髓空洞症术后疗效不佳者采用下疝小脑扁桃体切除+第四脑室流出道疏通术进行翻修是安全、可靠、有效方法.%Objective To study the methods and the curative effect of revision operation for Chiari I malformation complicated with syringomyelia followed surgical treatment.Methods The clinical data of 15 patients underwent revision operation for Chiari Ⅰ malformation complicated with syringomyelia followed surgical treatment from May 2004 to April 2013 were retrospectively reviewed,they still had symptoms and signs or/and suffered from symptoms aggravated.In the prior operation there were the enlargement decompression posterior cranial fossa in 8 cases,the decompression with resection of outer layer of the dura in 3 cases,the small bone window craniotomy decompression of posterior cranial fossa and resection of the hernia of cerebella tonsil in 2 cases,the decompression of posterior cranial fossa and dura plastic repair in 2 cases.The resection of the hernia of cerebella tonsil and exploration the fourth ventricle outlet were performed in the revision operation of 15 cases,reconstruction of the fourth ventricle outlet in 3 cases.Results The follow-up study from 4 months to 47 months (average 24.1 months) shown that symptoms were disappeared in 8 cases,significantly improved in 3 cases,improved in 4 cases,and syringomyelia decreased in all cases.Conclusions The resection of the hernia of cerebella tonsil and reconstruction of the fourth ventricle outlet is a safe,reliable and effective treatment for patients with failure surgical management of Chiari Ⅰ malformation complicated with syringomyelia.