小脑扁桃体切除联合后颅窝重建术治疗合并脊髓空洞症的Chiari-Ⅰ畸形  

Posterior fossa reconstruction in the treatment of Chiari Ⅰ malformation associated with syringomyelia

作　　者：张秋建[1] 王文浩[1] 

机构地区：[1]解放军第一七五医院神经外科,福建漳州363000

出　　处：《临床医学》2012年第3期14-16,共3页Clinical Medicine

摘　　要：目的探讨软膜下切除小脑扁桃体及后颅窝重建术治疗合并脊髓空洞症的Chiari-I畸形的方法及疗效。方法 2005年1月至2010年6月采用小脑扁桃体切除联合后颅窝重建术治疗39例合并脊髓空洞症的Chiari-I畸形患者。手术中先行后颅窝减压,咬除部分枕骨鳞部、枕大孔后缘和寰椎后弓;在保持软膜的完整的前提下将下疝至颈椎管内的小脑扁桃体作软膜下吸除;再将四脑室正中孔处的粘连松解,并将脊髓中央管开口处的隔膜剪开;最后用人工硬膜修补材料减张缝合硬膜。结果术后随时间推移,33例(84.62%)患者的神经症状明显好转,2～3个月后复查MRI见下疝的小脑扁桃体下端已经上移至枕大孔平面以上,枕大池形成良好,延髓和上颈髓后方无压迫,扩张的脊髓中央管明显缩小。结论利用显微神经手术在软膜下切除下疝的小脑扁桃体及后颅窝重建术是治疗合并脊髓空洞症的Chiari-I畸形的一种有效方法。Objective To study the method and effect of resection of cerebellar tonsil combined with posterior fossa reconstruction in the treatment of Chiari I malformation patients with syringomyelia.Methods A total of 39 syringomyelia patients suffered from Chiari Ⅰ malformation received resection of the cerebellar tonsil combined with posterior fossa reconstruction from January 2005 to June 2010.Patients underwent surgical intervention in the prone position.including suboccipital craniectomy and foramen magnum decompression,laminectomy of posterior arch of C1,resection of the cerebellar tonsil,intradural exploration,lysis of arachnoid adhesions and confirming CSF flow outside from foramen of magendie.Results The rate of symptom improvement post-operation was 84.62%.The length of syringomyelia was decreased significantly.Conclusion Posterior fossa reconstruction is an useful option for the treatment of Chiari I malformation patients with syringomyelia.

关 键 词：Chiari-I畸形 脊髓空洞症 小脑扁桃体下疝 后颅窝重建 

分 类 号：R651[医药卫生—外科学]