神经内镜联合导航及术中超声多普勒治疗Chiari畸形Ⅰ型的疗效  

Efficacy study of Chiari type I malformation treatment using neuroendoscope assisted with neuronavigation and intraoperative ultrasound

作　　者：姚晓辉[1] 成睿[1] 张世渊[1] 吉宏明[1] Yao Xiaohui;Cheng Rui;Zhang Shiyuan;Ji Hongming(Neurosurgery Department,Shanxi Provincial People＇s Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院神经外科,太原030012

出　　处：《中华神经外科杂志》2018年第9期937-940,共4页Chinese Journal of Neurosurgery

基　　金：山西省社会发展科技攻关项目（20140313011-5）

摘　　要：目的探讨神经内镜联合导航及术中超声多普勒治疗Chiari畸形Ⅰ型的临床效果。方法回顾性纳入山西省人民医院神经外科2011年1月至2017年6月采用神经内镜诊治的132例Chiari畸形I型患者，其中98例合并脊髓空洞。均采取改良小骨窗寰枕减压术，术中均使用神经导航；其中34例行术中超声多普勒监测脑脊液流速，根据脑脊液流速决定是否行硬膜外层切开。依据Tator评价标准评估疗效（优为症状改善，良为稳定，差为恶化）。结果132例患者术后随访6～24个月，平均（11±6）个月。末次随访疗效优92例，良36例，差4例，临床症状改善率为69．7％（92／132）。其中术中未行超声多普勒监测组的临床改善率为65．3％（64／98），监测组的改善率为82．4％（28／34），差异无统计学意义（P=0．06）。术后合并脊髓空洞者MRI随访78例，临床症状改善率为41．0％（32／78）。术后无枕部皮下积液及脑脊液漏等手术相关并发症发生，颅内感染4例。结论神经内镜联合导航及术中超声多普勒行单纯骨性减压及硬膜外层切开治疗Chiari畸形Ⅰ型疗效满意，并发症发生率低。Objective To explore and evaluate the clinical outcome of neuroendoscopic treatment assisted with neuronavigation and intraoperative ultrasound for Chiari type I malformation. Methods Between January 2011 to June 2017, 132 patients underwent neuroendoscopic atlantooecipital decompression at Neurosurgery Department of Shanxi Provincial People＇s Hospital. During the operations, the surgical fields were lightened by the illuminator of endoscope. All manipulations were conducted with neuronavigation. Intraoperative ultrasound was applied in 34 cases to detect the flowing speed of eerebrospinal fluid （CSF） which determined whether the outer dura was opened. We evaluated the clinic efficacy based on the Tator criteria which was classified into excellent （symptomatic improvement）, good （symptomatic stability） and poor （ symptomatic worsening）. Results All 132 patients had follow-up lasting for 6 - 24 months. There were 92 patients who were determined as excellent in recovery, 36 as stable and 4 as worse. The clinical symptoms were improved in 69.7% （92/132）. The clinical symptoms were improved in 65.3 % （64/98） of the cases without intraoperative ultrasound and 82.4% （28/34） among those with intraoperative ultrasound, although there was no significant difference （ P = 0.06 ）. MRI follow-up was conducted in 78 cases with comorbidity of myelosyringosis, which was improved in 41.0% （32/78）. There were no cases of scalp hydrops in the occipital area or cerebrospinal fluid leakage post operation. Four cases reported intracranial infection. Conclusion Neuroendoscope-assisted atlantooccipital decompression, combined with neurona- vigation, intraoperative ultrasound and dura opening, seems to have satisfactory effect in treatment of Chiari type I malformation and low complication rate, which still needs study involving larger number of samples.

关 键 词：Arnold—Chiari畸形 自然腔道内镜手术 神经导航 超声检查 多普勒 寰枕减压术 

分 类 号：R651[医药卫生—外科学]