摘要
目的 探讨Chiari I畸形并脊髓空洞症手术治疗的适应证、手术方式及效果。方法对 2 4 7例磁共振成像 (MRI)证实的Chiari I畸形并脊髓空洞症患者的手术治疗情况进行回顾性分析。MRI征象为小脑扁桃体下疝及伴轻度脊髓空洞者 12 6例、小脑扁桃体下疝并脊髓空洞达第二颈椎(C2 )以上者 38例、小脑扁桃体下疝严重达C2 ～C3 水平并脊髓远隔节段空洞者 6 7例、小脑扁桃体下疝严重达C2 ～C3 水平脊髓空洞达C2 以上者 16例。患者分别行后颅窝减压术、后颅窝减压及脊髓空洞切开引流术、后颅窝减压及小脑扁桃体切除术、后颅窝减压加脊髓空洞切开引流及小脑扁桃体切除术。结果 出院时患者症状明显改善或改善者 197例 (79 8% ) ,无改善但病情稳定者 39例(15 8% ) ,恶化者 7例 (2 8% ) ,死亡者 4例 (1 6 % )。随访 10 7例患者 ,复查MRI脊髓空洞消失或基本消失者 78例 ,缩小者 14例 ,无改变者 15例。结论 后颅窝减压术、脊髓空洞切开引流术、小脑扁桃体切除术及其不同组合是治疗Chiari I畸形并脊髓空洞症的有效方法。
Objective To discuss the surgical treatment of chiariI malformation complicated with syringomyelia. Methods The surgical treatments of 247 cases were analyzed retrospectively. The indication of operation styles was proposed by various surgical treatment to different MRI(magnetic resonance imaging) findings. MRI findings includes: tonsillar herniation with no or slight syringomyelia(126 cases), tonsillar herniation with syringomyelia above C 2(second cervical vertebrae) vertebral level(38 cases), serious tonsillar herniation(to C 2～C 3 level ) with syringomyelia of isolated spinal segments(67 cases), serious tonsillar herniation(to C 2～C 3 level ) with syringomyelia above C 2 vertebral level(16 cases). They were performed by posterior fossa decompression, posterior fossa decompression and incision of the syringomyelia, posterior fossa decompression and resection of the cerebellar tonsils, posterior fossa decompression and incision of the syringomyelia combined with resection of the cerebellar tonsils respectively. Results The clinical signs and symptoms had been markedly improved or improved in 197 cases (79.8%) until patients were discharged from hospital,unchanged in 39 cases (15.8%),deteriorated in 7 cases (2.8%).there were 4 death in all cases after surgery. 107 cases were followed up from 5 months to 9 years.The postoperative MRI findings in the 107 patients demonstrated that the cavities in spinal cords disappeared completely or nearly in 78 cases,reduced in 14 cases,unchanged in 15 cases. Conclusions Posterior fossa decompression, posterior fossa decompression and incision of the syringomyelia, posterior fossa decompression and resection of the cerebellar tonsils, posterior fossa decompression and incision of the syringomyelia combined with resection of the cerebellar tonsils should be an effective method for treatment of chiariI malformation complicated with syringomyelia. Surgical treatment may fully ameliorate the clinical syndromes.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2004年第19期1189-1192,共4页
Chinese Journal of Surgery
