38例Chiari畸形伴脊髓空洞症的微创手术治疗体会(2)
我们通过对38例患者的临床研究。认为枕颈部通畅的蛛网膜下腔重建是此微创手术的关键[8],手术侧重于解除枕颈交界处的障碍,打通蛛网膜下腔的梗阻, 恢复脑脊液的循环。手术时在显微镜下操作:照明充分、副损伤小、止血彻底,充分松解小脑扁桃体间及与延髓背侧的粘连,分离正中孔处的粘连,改善脑脊液从第四脑室、小脑延髓侧池循环的通畅程度,分离硬膜与蛛网膜的粘连,术中无血化操作及保持蛛网膜的完整可防止术后脑脊液漏的发生,是降低术后感染机率的关键,同时可有效防止出血进入蛛网膜下腔从而减少术后蛛网膜粘连的发生,此手术方式取得良好的治疗效果,并且明显降低并发症的发生。枕大孔区减压硬膜成形微创术在临床中值得应用与推广。
参 考 文 献
[1] 李定君,游潮.Arnold-Chiari畸形的MR研究及临床应用. 华西医学, 2004,19(4) : 671-672.
[2] Milhorat TH, Bolognese PA. Tailored operative technique for Chiari type I malformation using in traoperative color Dopplerul trasonography. Neurosurgery, 2003, 53(4): 899-905.
[3] Oldfield EH , Muraszko K, Shawker TH, et al. Pathophysiology of syringomyelia associated with Chiari Ⅰ malformation of the cerebellar tonsils. Imp lications for diagnosis and treatment. J Neurosurg, 1994, 80(1):3-15.
[4] Schijman E, Steinbok P. International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst, 2004,20(5): 341-348.
[5] Anderson RC, Emerson RG, Dowling KC, et al. Improvement in brainstem auditory evoked potentials after suboccipital decompression in patients with chiari I malformations. J Neurosurg, 2003, 98(3): 459-464.
[6] Di Lorenze N, Palma L, Palatinsky E, et al. "Conservative" cranio-cervical decompression in the treatment of syringomyelia Chiari Ⅰcomplex. A prospective study of 20 adult cases. Spine (Phila Pa 1976) , 1995, 20 (23) : 2479 - 2483.
[7] 张远征,乔广宇,佟怀宇,等.ChiariⅠ畸形伴脊髓空洞症的分型和手术方式的选择.中国微侵袭神经外科杂志,2004,9(10):445-448.
[8] 赵红宇,于宏伟,王成林.Arnold-Chiari畸形并脊髓空洞症125例手术治疗疗效评价.中国神经精神疾病杂志,2006,32(1):49-52., 百拇医药(黄华东 黄海能 邓元央 罗起胜 符黄德 李传玉)
参 考 文 献
[1] 李定君,游潮.Arnold-Chiari畸形的MR研究及临床应用. 华西医学, 2004,19(4) : 671-672.
[2] Milhorat TH, Bolognese PA. Tailored operative technique for Chiari type I malformation using in traoperative color Dopplerul trasonography. Neurosurgery, 2003, 53(4): 899-905.
[3] Oldfield EH , Muraszko K, Shawker TH, et al. Pathophysiology of syringomyelia associated with Chiari Ⅰ malformation of the cerebellar tonsils. Imp lications for diagnosis and treatment. J Neurosurg, 1994, 80(1):3-15.
[4] Schijman E, Steinbok P. International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst, 2004,20(5): 341-348.
[5] Anderson RC, Emerson RG, Dowling KC, et al. Improvement in brainstem auditory evoked potentials after suboccipital decompression in patients with chiari I malformations. J Neurosurg, 2003, 98(3): 459-464.
[6] Di Lorenze N, Palma L, Palatinsky E, et al. "Conservative" cranio-cervical decompression in the treatment of syringomyelia Chiari Ⅰcomplex. A prospective study of 20 adult cases. Spine (Phila Pa 1976) , 1995, 20 (23) : 2479 - 2483.
[7] 张远征,乔广宇,佟怀宇,等.ChiariⅠ畸形伴脊髓空洞症的分型和手术方式的选择.中国微侵袭神经外科杂志,2004,9(10):445-448.
[8] 赵红宇,于宏伟,王成林.Arnold-Chiari畸形并脊髓空洞症125例手术治疗疗效评价.中国神经精神疾病杂志,2006,32(1):49-52., 百拇医药(黄华东 黄海能 邓元央 罗起胜 符黄德 李传玉)