Chiari畸形Ⅰ型合并睡眠呼吸暂停综合征的手术治疗分析  

Microsurgery for Chiari malformation type Ⅰ associated with central sleep apnea hypopnea sydrome(report of 6 cases)

作　　者：强京灵 田德洲[1] 张远征[1] QIANG Jing-ling;TIAN De-zhou;ZHANG Yuan-zheng(Department of Neurosurgery,The Affiliated Hospital,Yan'an University,Yan'an 716000,China)

机构地区：[1]延安大学附属医院神经外科,陕西延安716000

出　　处：《中国临床神经外科杂志》2018年第8期529-531,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨手术干预Chiari畸形对Chiari畸形Ⅰ型合并有睡眠呼吸呼吸暂停综合征(CSAS)病人睡眠的影响。方法回顾性分析2012年7月至2016年5月收治的6例Chiari畸形Ⅰ型合并CSAS的临床资料,均行后正中入路软膜下下疝小脑扁桃体切除及枕大池重建术。术前、术后3个月行多导睡眠呼吸监测记录进入深睡眠至少4 h以上的呼吸暂停次数、每次暂停时间及每次暂停时的最低血氧饱和度。结果术后3个月,呼吸暂停次数明显减少,暂停持续时间下降,血氧饱和度上升,临床表现明显改善。术后复查MRI示下疝的扁桃体切除,延颈髓背侧压迫解除,脑脊液循环通畅,部分合并脊髓空洞较术前缩小,甚至有部分脊髓空洞完全消失。结论 Chiari畸形Ⅰ型合并睡眠呼吸暂停综合征,通过颈后正中入路软膜下下疝小脑扁桃体切除及枕大池重建术,能够明显改善病人睡眠呼吸暂停情况。Objective To explore the effects of microsurgery on sleep in the patients with Chiari malformation typeⅠ(CM-1)associated with central sleep apnea hypopnea sydrome(CSAS).Methods The cerebellar herniation tonsillectomy through subpial posterior and midline inferior approach and reconstruction of cisterna magna were performed in 6 patients with CM-1 associated with CSAS.The number of overnight apnea and minimum oxygen saturation at each pause time and every pause duration over 4 hours after deep sleep were determined with polysomnography before and 3 months after the operation in all the patients.Results Following-up 3 months after the operation showed that the symptoms,including the number of apnea,respiratory pause duration,oxygen saturation and so on,were relieved or disappeared in all the patients compared with before the operation(P<0.05).MRI 3 months after the operation showed that the herniated cerebellar tonsils were removed and the syringomyelia shrank or disappeared in all the patients.Conclusions The symptoms including sleep apnea and so on may be improved by the removal of herniated cerebellar tonsil with the surgery through supial posterior and midline approach and reconstruction of cisterna mana in the patients with CM-1 associated with CACS.

关 键 词：CHIARI畸形 中枢性睡眠呼吸暂停综合征 手术 

分 类 号：R742.82[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]