Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation
Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation
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DOI：
10.1007/s007010050401
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发表时间：
1999-01-01
影响因子：
2.4
通讯作者：
Inoue, Y
中科院分区：
文献类型：
--
作者：
Sakamoto, H;Nishikawa, M;Inoue, Y
为了治疗与成人型Chiari畸形相关的脊髓空洞症，作者提出了一种扩张枕下颅骨成形术(ESC)的方法，扩大小的后颅窝以获得足够的脑脊液(CSF)流量。对20例大池无蛛网膜粘连的患者行大池无蛛网膜粘连的ESC术，未切开大池蛛网膜。术后均有改善，无复发，脑脊液核磁共振成像研究显示大池血流明显改善。另20例无蛛网膜下腔粘连的患者同时行ESC，但行OBEX封堵术。16例改善，1例暂时改善，术后蛛网膜粘连导致脊髓空洞症复发。其余3例在术后磁共振成像上显示空洞缩小，但无变化。这三名患者在大约10年的时间里表现出了手术前的症状，几乎累及了整个脊髓轴面，并在手术前出现了巨大的脊髓空洞。在4例蛛网膜粘连的患者中，除ESC外，所有患者都需要进行蛛网膜下腔手术，对于无蛛网膜粘连的患者，无需进行蛛网膜下腔手术以促进脑脊液的恢复，因为ESC即使在不堵塞OBEX的情况下也可以解除大脑池中的脑脊液流动障碍。合并蛛网膜粘连的大池或长期存在的脊髓空洞并不可逆的脊髓损伤会导致不良的手术预后。当后颅窝手术失败时，大脑池减压不足或术后蛛网膜粘连是治疗失败的原因，应通过相位对比磁共振成像进行脑脊液血流检测。
In order to treat syringomyelia associated with adult type Chiari malformation, the authors developed a method of expansive suboccipital cranioplasty (ESC) that involves enlarging the small posterior fossa to obtain a sufficient flow of cerebrospinal fluid (CSF). The relative effectiveness of ESC with the obex plugged and not plugged was also examined, as well as other factors influencing the operative results.Twenty patients without arachnoid adhesion at the major cistern underwent ESC without opening the arachnoid membrane at the major cistern. After surgery, all improved with no recurrence and CSF how study using magnetic resonance (MR) imaging showed significant improvement of the flow at the major cistern. Another 20 patients without arachnoid adhesion also underwent ESC but with obex plugging. Sixteen improved and one displayed only temporary improvement with recurrent syringomyelia due to postoperative arachnoid adhesions. The remaining three showed no change in spite of shrinkage of the syrinx on postoperative MR imaging. These three patients had displayed pre-operative symptoms over an approximately 10-year period involving almost the entire axial plain of the spinal cord, and presented a large syrinx before surgery. In 4 patients with arachnoid adhesions, all required intra-arachnoid procedures in addition to ESC.Intra-arachnoid procedures are not necessary to facilitate restoration of CSF how in patients without arachnoid adhesions, because ESC can release the CSF flow blockage in the major cistern even without plugging of the obex. An associated arachnoid adhesion at the major cistern or a long-standing syringomyelia with irreversible damage of the spinal cord results in a poor operative prognosis. When posterior fossa surgery fails, insufficient decompression or postoperative arachnoid adhesions at the major cistern as the cause of treatment's failure should be evaluated by CSF flow studies using phase contrast MR imaging.