Chiari I型畸形合并脊髓空洞症的显微外科治疗

陈军 李爱民 陈覃 吴海滨 许祥飞 司宪平 施辉 王富元

徐州医学院附属连云港医院神经外科,连云港市222002

[e-mail]

[摘要] 目的 研究Chiari I型畸形合并脊髓空洞症的的显微手术治疗方法。方法 枕下正中入路，咬开枕大孔后缘及寰椎后弓，显微镜下切开硬脑脊膜，软脑膜下吸除下疝的小脑扁桃体，重建第四脑室正中孔与两侧小脑延髓外侧池交通、开放脊髓中央管口，修补硬脑脊膜。结果 36例术中发现30例有脊髓中央管口活瓣样假膜。随访3月～5年, MRI复查6例脊髓空洞症消失，30例明显缩小。结论 采用显微手术吸除下疝的小脑扁桃体，开放脊髓中央管口，恢复枕大池结构和功能，是治疗Chiari I型畸形合并脊髓空洞症的关键。连云港市第一人民医院神经外科陈军

[关键词] ChiariI型畸形；脊髓空洞症；假膜；小脑扁桃体；枕大池

Microsurgical treatment of the Chiari type I malformation complicated with　syringomyelia  CHEN Jun, LI Aimin，CHEN Tan, et al. Departtment of Neurosurgery, Lian Yun Gang Hospital of Xuzhou Medical College, Lianyungang 222002

【Abstract】 Objective To introduce a microsurgical procedure for treating Chiari type I malformation complicated with　syringomyelia by removement of cerebella tonsils and plastic operation of cistern magna. Methods Suboccipital craniotomy and laminectomy of C₁ were performed, inferior nuchal linear as the superior edge of bone window. The dura and arachnoid were opened like as “Y” shape. The cerebellar tonsils were removed subpially and peel off conglutination, the communication of CSF between the fourth ventricle and subarachnoid space was achieved. The　Pseduomembrane that is a very thin membrane over the opening of the central canal should be cut away, with the fascia graft, a new enlarged cistern magna was developed.  Results 36 patients with Chiari type I malformation complicated with　syringomyelia were operated on using this technique. The　pseduomembrane  was found in 30 patients. All cases were followed up from 3 months to 5 years. Postoperative MRI revealed the size of the syrinx cavity decreased in all cases, disappeared in 6 cases. The improvement of symptom of sensation and muscle tone was obvious . Conclusions  The microsurgical procedure of the tonsillectomy, the cutting of the pseduomembrane , the communication of CSF between the fourth ventricle and subarachnoid space ,and the enlarged cistern magna are the ideal operated treatment for the Chiari type I malformation complicated with　syringomyelia.

【Key words】 Chiari type I; Cistern magna；Syringomyelia；Pseduomembane ; Cerebellar tonsils；Cistern magna