魏振宇;王帮庆;胡森;闫兆月;周志龙;步星耀;

• 1:新乡医学院第二附属医院
• 2:河南省省立医院
• 3:河南省人民医院/郑州大学人民医院/河南大学人民医院

摘要(Abstract)：

目的分析寰枕部骨、膜双减压整复治疗ChiariⅠ畸形的临床疗效。方法对郑州大学人民医院神经外科2016-06—2018-06收治的56例ChiariⅠ畸形患者进行回顾性分析,所有患者采用寰枕部骨、膜双减压整复手术,采用Tator评价标准作为术后疗效评估指标,术后复查MRI检测颅颈交界区解剖变化,应用术中超声辅助检测硬膜内层脑脊液流速作为预后指标。结果 56例患者术后MRI显示枕大池重建满意,小脑扁桃体上移复位,脊髓空洞缩小。术中5例患者超声提示脑脊液流速<3 cm/s,术后近期效果稳定,随访1 a后3例症状改善显著,2例症状改善一般,脑脊液流速≥3 cm/s,术后症状缓解时间明显缩短。所有患者末次随访依据Tator评价标准提示,优54例,良2例。结论寰枕部骨、膜双减压整复治疗ChiariⅠ畸形通过纠正后颅窝解剖狭小畸形,恢复解剖结构,改善脑脊液循环途径,是治疗ChiariⅠ型畸形的一种临床有效、可靠的新型手术方案。术中超声可作为判断预后的一种检测方法。

关键词(KeyWords)： ChiariⅠ畸形(CMⅠ);微创手术;整复术;术中超声;脑脊液流速

Abstract:

Keywords:

基金项目(Foundation): 河南省科技攻关重点项目(编号:192102310126);; 河南大学教育发展基金(编号:2019004)

作者(Authors): 魏振宇;王帮庆;胡森;闫兆月;周志龙;步星耀;

参考文献(References)：

• [1] B?RCEK A ?,ASLAN A.Unexpected Progression of Tonsillar Herniation in Two Pediatric Cases with Chiari Malformation Type Ⅰ and Review of the Literature[J].Pediatr Neurosurg,2019,54(1):51-56.DOI:10.1159/000495066.
• [2] MORGENSTERN P F,TOSI U,URIBE-CARDENAS R,et al.Ventrolateral Tonsillar Position Defines Novel Chiari 0.5 Classification[J].World Neurosurg,2020,136:444-453.DOI:10.1016/j.wneu.2020.01.147.
• [3] SEAMAN S C,DAWSON J D,MAGNOTTA V,et al.Fourth Ventricle Enlargement in Chiari Malformation Type Ⅰ[J].World Neurosurg,2020,133:e259-e266.DOI:10.1016/j.wneu.2019.08.230.
• [4] SELCUKI M,METE M,SELCUKI D.Are Herniated Cerebellar Tonsils the Main Culprit of Chiari Malformation Type Ⅰ Symptoms?The Brainstem Compression Hypothesis seems to be Re-Elucidated and Revised[J].Turk Neurosurg,2018,28(1):67-71.DOI:10.5137/1019-5149.JTN.18349-16.1.
• [5] ANAND L K,MALHOTRA A,SAOAR R,et al.Anesthetic management of a patient with syringomyelia and Arnold-Chiari malformation Type Ⅰ with autonomic dysfunction[J].Anaesthes Pain Intens Care,2019:408-411.
• [6] PATHMANABAN O N,BURKE K A,LEACH P,et al.Nonsynostotic Posterior Brachycephaly with Hindbrain Herniation[J].World Neurosurg,2017,97:755.e11-755.e15.DOI:10.1016/j.wneu.2016.10.027.
• [7] MALEKZADEHLASHKARIANI S,WANKE I,RüFENACHT D A,et al.Brain herniations into arachnoid granulations:about 68 cases in 38 patients and review of the literature[J].Neuroradiology,2016,58(5):443-457.DOI:10.1007/s00234-016-1662-5.
• [8] BARRETO E Q S,CAVALHEIRO S,MILANI H J F,et al.Cerebellar herniation demonstrated by the occipitum-dens line:Ultrasonography assessment of normal fetuses,fetuses with myelomeningocele,and fetuses that underwent antenatal myelomeningocele surgery[J].Prenat Diagn,2018,38(4):280-285.DOI:10.1002/pd.5229.
• [9] SOLEMAN J,BARTOLI A,KORN A,et al.Treatment failure of syringomyelia associated with Chiari Ⅰ malformation following foramen magnum decompression:how should we proceed?[J].Neurosurg Rev,2019,42(3):705-714.DOI:10.1007/s10143-018-01066-0.
• [10] ORAL S,YILMAZ A,KUCUK A,et al.Comparison of dural splitting and duraplasty in patients with Chiari type Ⅰ malformation:relationship between tonsillo-dural distance and syrinx cavity[J].Turk Neurosurg,2019,29(2):229-236.DOI:10.5137/1019-5149.JTN.23319-18.2.
• [11] ITO K,YAMADA M,HORIUCHI T,et al.Appropriate surgical procedures for Chiari type 1 malformation and associated syrinx based on radiological characteristics of the craniovertebral junction[J].Neurosurg Rev,2019:1-6.DOI:10.1007/s10143-019-01079-3.
• [12] TANG C,ZHU J,FENG K,et al.Successful Treatment of Spontaneous Cerebrospinal Fluid Rhinorrhea With Endoscopic Third Ventriculostomy and Lumboperito-neal Shunt:A Case Report[J].Front Neurosci,2020,14.DOI:10.3389/fnins.2020.00057.
• [13] SHETTY J,KANDASAMY J,SOKOL D,et al.Clinical deterioration despite syringomyelia resolution after successful foramen magnum decompression for Chiari malformation-Case series[J].Eur J Paediatr Neurol,2019,23(2):333-337.DOI:10.1016/j.ejpn.2019.01.003.
• [14] EPPELHEIMER M S,BISWAS D,BRAUN A M,et al.Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1[J].Neuroradiology,2019,61(9):1011-1022.DOI:10.1007/s00234-019-02206-z.
• [15] MASSIMI L,FRASSANITO P,CHIEFFO D,et al.Bony decompression for Chiari malformation type Ⅰ:long-term follow-up[J].Acta Neurochir Suppl,2019,125:119-124.DOI:10.1007/978-3-319-62515-7_17.
• [16] HOLLY L T,BATZDORF U.Chiari malformation and syringomyelia:JNSPG 75th Anniversary Invited Review Article[J].J Neurosurg,2019,31(5):619-628.DOI:10.3171/2019.7.SPINE181139.
• [17] LAN Q,SUGHRUE M,HOPF N J,et al.International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery[J].Neurosurg Rev,2019:1-17.DOI:10.1007/s10143-019-01188-z.
• [18] MILANO J B,BARCELOS A C E S,ONISHI F J,et al.The effect of filum terminale sectioning for Chiari 1 malformation treatment:systematic review[J].Neurol Sci,2019:1-8.DOI:10.1007/s10072-019-04056-2.
• [19] CAFFO M,CARDALI S M,CARUSO G,et al.Minimally invasive posterior fossa decompression with duraplasty in Chiari malformation type Ⅰ with and without syringomyelia[J].Surg Neurol Int,2019,10.DOI:10.25259/SNI-70-2019.
• [20] EPPELHEIMER M S,BISWAS D,BRAUN A M,et al.Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1[J].Neuroradiology,2019,61(9):1011-1022.DOI:10.1007/s00234-019-02206-z.
• [21] DJEKIDEL M,LECKMAN J F,COHEN B H,et al.99mTc HMPAO Cerebral Blood Flow Imaging Reveals Tourette’s Network when Compared to Healthy Controls[J].J Nucl Med Radiat Ther,2019,10(410):2.
• [22] FlINT G,BRODBELT A.Syringomyelia-Chiari 2018[J].Br J Neurosurg,2019,33(2):237-250.
• [23] PIPER R J,PIKE M,HARRINGTON R,et al.Chiari malformations:principles of diagnosis and management[J].BMJ,2019,365:l1159.DOI:10.1136/bmj.l1159.