通道辅助微创后颅窝减压手术治疗ChiariⅠ型  

Tube-assisted minimally invasive posterior decompression for ChiariⅠmalformation

作　　者：雷伟 宋振全 李晋江 李靖远 张晓斌 潘冬生 LEI Wei;SONG Zhenquan;LI Jinjiang;LI Jingyuan;ZHANG Xiaobin;PAN Dongsheng(Department of Neurosurgery,General Hospital of Northern Theater Command,Shenyang,Liaoning 110016,China)

机构地区：[1]北部战区总医院神经外科,辽宁沈阳110016

出　　处：《中华神经外科疾病研究杂志》2024年第2期35-39,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的评估应用通道辅助进行微创后颅窝减压手术治疗ChiariⅠ型畸形(CM-1)的临床效果.方法在2020年3月至2021年2月期间,北部战区总医院神经外科对20例CM-1成人患者进行了通道辅助下的后颅窝减压手术.其中13例采用显微镜技术,7例采用神经内镜技术.本研究通过回顾性分析,评估了手术前后神经功能、影像学检查结果、术后并发症以及术后12个月的颈椎日本骨科协会评分(JOA).结果20例患者在术后均有不同程度的症状改善,颈椎JOA评分平均恢复率为65.3%.术后MRI检查显示,3例患者的脊髓空洞完全消失,16例缩小,1例无变化.术后出现3例硬膜外积液和1例轻度感染,但无患者需要二次手术.结论通道辅助的微创后颅窝减压手术能够缓解脊髓压迫,有效减小脊髓空洞,并改善临床症状.该技术具有肌肉损伤小、恢复快的优点,是一种安全有效的治疗CM-1的手术方式.Objective To evaluate the clinical outcomes of minimally invasive posterior fossa decompression surgery assisted by a tubular retractor system for the treatment of Chiari Type I malformation(CM-1).Methods Between March 2020 and February 2021,20 adult patients with CM-1 underwent posterior fossa decompression surgery assisted by a tubular retractor system at the Department of Neurosurgery,Northern Theater Command General Hospital.Thirteen cases were performed under microscopic guidance,and seven cases under endoscopic guidance.This study retrospectively analyzed pre-and postoperative neurological functions,imaging findings,postoperative complications,and the cervical Japanese Orthopedic Association(JOA)scores at 12-month follow-up.Results All of the 20 patients showed varying degrees of symptom improvement postoperatively,with an average cervical JOA recovery rate of 65.3%.Postoperative MRI of the syrinx revealed complete resolution in three cases,reduction in 16 cases,and no change in one case.There were three cases of postoperative epidural fluid accumulation and one case of mild infection,with no case requiring further surgery.Conclusions Minimally invasive posterior fossa decompression surgery for Chiari Type I malformation assisted by a tubular retractor system effectively reduces the syrinx,alleviates spinal cord compression,and improves clinical symptoms.This surgical approach is characterized by minimal muscle injury and rapid recovery,making it a safe and effective treatment method for Chiari I malformation.

关 键 词：ChiariⅠ畸形 脊髓空洞症 后颅窝减压术 微创神经外科 通道 

分 类 号：R651.1[医药卫生—外科学]