【摘要】 目的 :讨论Chiari畸形外科治疗中不同手术方法与治疗效果及并发症的相关性问题 .方法 :MRI确诊的Chiari畸形患者 1 89例 ,其中Ⅰ型 30例 ,Ⅱ型 1 31例 ,Ⅲ型 2 8例 .均采用枕后正中入路减压术 ,依病情选择不同的减压范围、是否切开硬脑膜、是否切除下疝的扁桃体、以及是否行脊髓空洞分流术等 ,分析不同的手术方式与患者恢复情况的关系 ,确定各类型Chiari畸形的最佳治疗方法 .结果 :术后所有患者症状均有不同程度改善 .恢复情况 :优 1 6 8例 ,中 1 7例 ,差 4例 ,无手术死亡 .术后近期所有患者未发生严重并发症 ,术后 3mo发生脑积水 2例 ,行脑室腹腔分流术后治愈 .结论 :针对不同的类型及不同临床表现的Chiari畸形患者 ,采用恰当的手术方法可望取得满意的治疗效果更多还原

【Abstract】 AIM: To discuss the choice of different surgical modalities, their curative effects and postoperative complications in the treatment of Chiaris malformation. METHODS: One hundred and eighty nine cases of Chiaris malformation (confirmed by MRI) were included in this report, among whom, 30 cases were type Ⅰ, 131 cases type Ⅱ and 28 cases type Ⅲ. Occipitocervical decompression by median suboccipital approach was performed in all the cases and different surgical modalities, including the region of decompression, and if needed, the opening of the dura, the resection of the herniated cerebelar tonsils and the incision of the syringomyelia, were chosen according to the types of Chiaris malformation and patients condition. In order to find out the optimal surgical modalities for different types of Chiaris malformation, the relationship between different surgical modalities and their curative effects was analyzed. RESULTS: Clinical signs and symptoms were improved to different degrees after operation in all the cases. The results showed that 168 cases were well improved, 17 cases moderately improved and 4 cases mildly improved. There was no death due to surgery and no other serious postoperative short term complications except for hydrocephalus in two cases 3 months after operation, who were cured by lateral ventriculo abdomen shunting. CONCLUSION: If proper surgical modalities are chosen according to the types of Chiaris malformation and patients manifestation, the results of surgery will be satisfactory.更多还原