Chiari畸形Ⅰ型并脊髓空洞症术后翻修的疗效观察  

The curative effect of revision operation for Chiari I malformation complicated with syringomyelia followed surgical treatment

作　　者：王曲[1] 高方友[1] 刘窗溪[1] 韩国强[1] 熊云彪[1] 王俊[1] 姚倍金[1] 尹浩[1] 廖昆[2] 

机构地区：[1]贵州省人民医院神经外科,贵阳550002 [2]贵州省兴义市人民医院神经外科

出　　处：《中华神经外科杂志》2014年第8期819-823,共5页Chinese Journal of Neurosurgery

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.

关 键 词：Chiari畸形Ⅰ型 脊髓空洞症 翻修手术 

分 类 号：R651[医药卫生—外科学]