Gambardella G, Caruso G, Caffo M, Germanò A, La Rosa G, Tomasello F
Neurosurgical Clinic, University of Messina, Italy.
Acta Neurochir (Wien). 1998;140(2):134-9. doi: 10.1007/s007010050074.
Numerous surgical procedures have been proposed for treatment of syringomyelia associated with Chiari I malformation, but the optimal treatment has not yet been uniformly standardised. The main aim of the surgical treatment of syringomyelia/Chiari I complex is directed toward restoration of physiological cerebrospinal fluid dynamic at the craniovertebral junction. We report the surgical results of eight patients, affected by syringomyelia and Chiari I malformation, age range from 18 to 62 years, treated by bony foramen magnum decompression combined with transverse microincisions of the outer layer of the dura mater. In an average postoperative follow-up period of two years neurological symptoms and signs improved in seven patients. Postoperative Magnetic Resonance showed a decrease in size of the syrinx in seven patients. These results suggest that foramen magnum decompression combined with transverse microincisions of the outer layer of the dura 1) is an effective and safe treatment option for syringomyelia and Chiari I malformation, 2) corrects the circulatory disturbances of cerebrospinal fluid dynamic, 3) leads to a decrease in size of the syrinx and to a significant improvement in neurological signs and symptoms, 4) avoids complications of intradural approaches and syringosubarachnoid shunting.
针对与Chiari I型畸形相关的脊髓空洞症，已经提出了许多外科手术方法，但最佳治疗方案尚未统一标准化。脊髓空洞症/Chiari I型复合体外科治疗的主要目标是恢复颅颈交界处的生理性脑脊液动力学。我们报告了8例患有脊髓空洞症和Chiari I型畸形的患者的手术结果，年龄在18至62岁之间，采用枕骨大孔减压联合硬脑膜外层横向微切口进行治疗。在平均两年的术后随访期内，7例患者的神经症状和体征有所改善。术后磁共振成像显示7例患者的空洞大小减小。这些结果表明，枕骨大孔减压联合硬脑膜外层横向微切口1）是治疗脊髓空洞症和Chiari I型畸形的一种有效且安全的治疗选择，2）纠正了脑脊液动力学的循环障碍，3）导致空洞大小减小以及神经体征和症状显著改善，4）避免了硬脊膜内入路和脊髓蛛网膜下腔分流的并发症。
