Klekamp J, Iaconetta G, Samii M
Department of Neurosurgery, Nordstadt Krankenhaus, Medizinische Hochschule, Hannover, Germany.
Neurosurgery. 2001 Mar;48(3):664-7. doi: 10.1097/00006123-200103000-00044.
Indications for surgery and the surgical technique of foramen magnum decompression for patients with Chiari I malformation and syringomyelia are controversial issues. This case report supports the view that observation may be adequate for patients without progressive symptoms or with mild clinical symptoms.
A 37-year-old woman presented with a 3-month history of burning dysesthesias and hypesthesia in her right arm. A neurological examination revealed hypesthesia in the right trigeminal distribution. A magnetic resonance imaging scan revealed a Chiari I malformation with syringomyelia between C2 and T2. No hydrocephalus was observed.
Because the patient's symptoms regressed spontaneously, surgery was not performed. Thirty-two months after her initial examination, the patient was asymptomatic. A second magnetic resonance imaging scan was obtained, which demonstrated complete spontaneous resolution of the Chiari I malformation and syringomyelia.
We attribute the regression of the patient's symptoms to spontaneous recanalization of cerebrospinal fluid pathways at the foramen magnum, which most likely was due to rupture of the arachnoid membranes that had obstructed cerebrospinal fluid flow.
对于 Chiari I 畸形合并脊髓空洞症患者，手术指征及枕骨大孔减压术的手术技巧是存在争议的问题。本病例报告支持这样一种观点，即对于无进行性症状或临床症状较轻的患者，观察可能就足够了。
一名 37 岁女性，有 3 个月右臂烧灼样感觉异常和感觉减退病史。神经系统检查发现右侧三叉神经分布区感觉减退。磁共振成像扫描显示 Chiari I 畸形，C2 至 T2 水平存在脊髓空洞症。未观察到脑积水。
由于患者症状自发缓解，未进行手术。初次检查 32 个月后，患者无症状。再次进行磁共振成像扫描，结果显示 Chiari I 畸形和脊髓空洞症完全自发消退。
我们将患者症状的缓解归因于枕骨大孔处脑脊液通路的自发再通，这很可能是由于阻塞脑脊液流动的蛛网膜破裂所致。
