[1]黄建睿　卢培刚　钟启胜　王衍廷　赵振宇.保留枕骨大孔的颅后窝减压术治疗Ⅰ型小脑扁桃体下疝畸形的疗效[J].中国临床神经外科杂志,2020,(02):79-81.[doi:10.13798/j.issn.1009-153X.2020.02.006]
　HUANG Jian-rui,LU Pei-gang,ZHONG Qi-sheng,et al.Posterior fossa decompression with preservation of intact occipital foramen for Chiari malformation-Ⅰ[J].,2020,(02):79-81.[doi:10.13798/j.issn.1009-153X.2020.02.006]
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保留枕骨大孔的颅后窝减压术治疗Ⅰ型小脑扁桃体下疝畸形的疗效()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年02期
页码:
79-81
栏目:
论著
出版日期:
2020-02-25

文章信息/Info

Title:
Posterior fossa decompression with preservation of intact occipital foramen for Chiari malformation-Ⅰ
文章编号:
1009-153X（2020）02-0079-03
作者:
黄建睿　卢培刚　钟启胜　王衍廷　赵振宇
250031 济南，中国人民解放军联勤保障部队第960医院神经外科[黄建睿（现在山东省菏泽市立医院神经外科工作）、卢培刚、钟启胜、王衍廷、赵振宇]
Author(s):
HUANG Jian-rui1; 2;  LU Pei-gang1;  ZHONG Qi-sheng1;  WANG Yan-ting1;  ZHAO Zhen-yu1.
1. Department of Neurosurgery, The 960th Hospital, The People's Liberation Army Joint Service, PLA, Jinan 250031, China; 1. Department of Neurosurgery, Heze Municipal Hospital, Heze 274000, China
关键词:
Ⅰ型小脑扁桃体下疝畸形; 颅后窝减压术; 枕骨大孔; 疗效
Keywords:
Chiari malformation type Ⅰ;  Posterior fossa decompression;  Foramen magnum
分类号:
R 742.8+2; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2020.02.006
文献标志码:
A
摘要:
目的 探讨探讨保留枕骨大孔的颅后窝减压术治疗Ⅰ型小脑扁桃体下疝畸形 （ CM-Ⅰ）的疗效。方法 回顾性分析2015年1月至2016 年5月收治的21例CM-Ⅰ的临床资料。采用枕骨小骨窗减压（骨窗大小约2.5 cm×2.5 cm）及枕大池成形术，并保留枕骨大孔后缘约0.5 cm骨质。术前、术后1周、术后1年采用KPS评分、神经症状改善及小脑扁桃下疝程度评估疗效。结果 术后1周KPS评分[（66.52±9.8）分]较术前[（52.9±9.1）]明显增高（P<0.05）。术后1年KPS评分[（84.7±7.2）分]较术后1周明显增高（P<0.05）。术后1年神经症状改善率（90.48%，19/21）较术后1周（71.43%，15/21）明显提高（P<0.05）。术后1年小脑扁桃体下疝程度[超过枕骨大孔（2.9±1.8）mm]较术前[（4.1±1.4）mm]明显缩小（P<0.05）。结论 保留枕骨大孔的颅后窝减压+枕大池成形术是治疗 CM-Ⅰ安全、有效的方法。
Abstract:
Objective To investigate the clinical effect of the posterior fossa decompression with intact occipital foramen on Chiari malformation Ⅰ (CM-Ⅰ) without occipital foramen stenosis. Methods The clinical data of 21 CM-Ⅰ patients with syringomyelia, who underwent small bone window posterior fossa decompression and plastic surgery of cistern magna from January, 2015 to May, 2016, were analyzed retrospectively. The retained posterior margin of the occipital foramen was about 0.5 cm wide. The effects were observed 1 week and 1 year after the operation in all the patients. Results Kamofsky performance status scores [(52.9±9.1) points] were significantly lower before the operation than those [(66.52±9.8) points 1 week after the operation (P<0.05), which were significantly lower than those [(84.7±7.2) points] 1 year after the operation (P<0.05). The rates of symptom improvement 1 week and 1 year after the operation were 71.43% (15/21) and 90.48% (19/21) respectively. Conclusion The small bone window decompression and plastic operation of cistern magna with preservation of the posterior margin of the foramen magnum are an effective and safe method to treat CM-Ⅰ without occipital foramen stenosis.

参考文献/References:

[1] Hoffman CE, Souweidane MM. Cerebrospinal fluid-related complications with autologous duraplasty and arachnoid sparing in type Ⅰ Chiari malformation [J]. Neurosurgery, 2008, 62(3 Suppl 1): 156-161.
[2] Klekamp J. Surgical treatment of Chiari Ⅰ alformation-- analysis of intraoperative findings, complications, and out- come for 371 foramen magnum decompressions [J]. Neuro- surgery, 2012, 71(2): 365-380.
[3] Godil SS, Parker SL, Zuckerman SL, et al. Accurately mea- suring outcomes after surgery for adult Chiari Ⅰmalforma- tion: determining the most valid and responsive instruments [J]. Neurosurgery, 2013, 72(5): 820- 827.
[4] 李　京，秦燕霞，刘盼盼，等. 枕骨大孔的解剖学研究及其 临床意义[J]. 中国现代医学杂志，2018，28（14）：120-122.
[5] Genitori L, Peretta P, Nurisso C, et al. Chiari type I anoma- lies in children and adolescents: minimally invasive mana- gement in a series of 53 cases [J]. Childs Nerv Syst, 2000, 16(10-11): 707-718.
[6] Navarro R, Olavarria G, Seshadri R, et al. Surgical results of posterior fossa decompression for patients with Chiari Ⅰ malformation [J]. Childs Nerv Syst, 2004, 20(5): 349-356.
[7] Oró JJ, Mueller DM. Posterior fossa decompression and re- construction in adolescents and adults with the Chiari Ⅰ malformation [J]. Neurol Res, 2011, 33(3): 261-271.
[8] Litvack ZN, Lindsay RA, Selden NR. Dura splitting decom- pression for Chiari Ⅰ malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization [J]. Neurosurgery, 2013, 72(6): 922-929.
[9] Nishikawa M, Sakamoto H, Hakuba A, et al. Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa [J]. J Neurosurg, 1997, 86(1): 40-47.
[10] Guyotat J, Bret P, Jouanneau E, et al. Syringomyelia asso- ciated with type Ⅰ Chiari malformation: a 21-year retro- spective study on 75 cases treated by foramen magnum de- compression with a special emphasis on the value of tonsils resection [J]. Acta Neurochir (Wien), 1998, 140: 745-754.
[11] Durham SR, Fjeld-Olenec K. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation TypeⅠin pediatric patients: a meta-analysis [J]. J Neurosurg Pediatr, 2008, 2 (1): 42-49.
[12] 熊　兵. 两种手术方法治疗小脑扁桃体下疝畸形Ⅰ型并 脊髓空洞的疗效分析[D]. 遵义医学院，2016. 27.
[13] 吕学明，袁绍纪，张荣伟，等. Chiari畸形并脊髓空洞的治 疗与小脑扁桃体下疝分型[J]. 中国临床神经外科杂志， 2009，14（4）：211-212，216.
[14] 吕学明，袁绍纪，张荣伟，等. 小脑扁桃体下疝切除术治疗 Chiari畸形并脊髓空洞[J]. 中国临床神经外科杂志， 2010，15（3）：174-176.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81400919） 通讯作者：赵振宇，E-mail：zyzhao@yeah.net（2019-04-25 收稿，2019-09-15修回）
更新日期/Last Update: 2020-02-25