内镜手术治疗ChiariⅠ型畸形伴脊髓空洞症的初步探讨  

The preliminary study of using neuro-endoscope assisted atlantooccipital decompression to treat Chiari type Ⅰ malformation with syringomyelia

作　　者：高俊[1] 杨众[1] 李永宁[1] 王任直[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科,100730

出　　处：《中华外科杂志》2010年第19期1451-1453,共3页Chinese Journal of Surgery

摘　　要：目的 探讨应用神经内镜照明观察下进行寰枕减压手术治疗Chiari Ⅰ型畸形伴脊髓空洞的方法 和效果.方法 2007年1月至2008年1月,8例Chiari Ⅰ型畸形合并脊髓空洞患者接受了手术治疗.男性2例,女性6例;年龄13～52岁,平均37岁.手术方式为寰枕减压术,手术全程应用神经内镜照明观察术野,所有手术操作均在神经内镜鞘外进行.术中磨除后颅窝及寰椎部分骨质,减压骨窗约为2.0 cm ×2.0 cm;2例患者清除增厚的寰枕筋膜后未切开硬脑膜,其余6例患者切开硬脑膜.结果 8例患者术后恢复顺利,无并发症发生.随访过程中,根据Tator标准评价手术疗效,7例为优：痛温觉异常较术前明显改善（其中5例患者肌力有不同程度的提高）;1例为良：患者症状与术前相比无明显变化.结论 应用神经内镜照明观察术野,内镜鞘外操作进行寰枕减压术是微侵袭神经外科技术的一种新的尝试.Objective To explore and evaluate the methodology of neuro-endoscope assisted atlantooccipital decompression in Chiari type Ⅰ malformation with syringomyelia. Methods Between January 2007 to January 2008,8 patients underwent neuro-endoscope assisted atlantooccipital decompression,including 2 male patients and 6 female patients（aged 13 to 52 years）. During the operations, the surgical fields were lightened by the illuminator of endoscope. All the manipulations were done outside the sheath of neuroendoscope. The decompression bone window was about 2.0 cm × 2. 0 cm. After the atlantooccipital fascia was cleared thoroughly, dura were opened in 6 cases and intact in 2 cases. Results There were no complications observed in this study. Seven patients were determined as excellent in recovery according to the Tator criteria because of apparent improvements in superficial sensation. Five of the seven patients had improvements in muscle strength. One patient was assessed as good because of stable symptom without deterioration. Conslusion Neuro-endoscope assisted atlantooccipital decompression is a potential technique worthy of employing in the mini-invasive neurosurgictechnology.

关 键 词：ARNOLD-CHIARI畸形 脊髓空洞 神经内镜 寰枕减压 

分 类 号：R744.4[医药卫生—神经病学与精神病学]