Kohno K, Sakaki S, Nakamura H, Sakoh M, Takeda S, Sadamoto K
Department of Neurosurgery, Ehime University School of Medicine.
Neurol Med Chir (Tokyo). 1991 Nov;31(11):715-9. doi: 10.2176/nmc.31.715.
Anterior or posterior decompression of the foramen magnum was performed in three patients with syringomyelia associated with basilar impression and Chiari I malformation. The operative results were evaluated using the pre- and postoperative magnetic resonance (MR) images. Two patients with combined anterior and posterior cervicomedullary compression due to basilar impression and tonsillar descent received suboccipital craniectomy, upper cervical laminectomy, and dural plasty without any intradural manipulations via the posterior approach. One patient with prominent anterior cervicomedullary compression due to basilar impression and a sharp clivoaxial angle was operated on by the transoral anterior approach. Postoperatively, all patients showed a sustained shrinkage of the syrinx and rounding of the flattened cerebellar tonsils. Two patients showed upward movement of the herniated tonsils. All patients had improved symptoms during 2-4 years follow-up. Treatment of syringomyelia associated with basilar impression and Chiari I malformation requires more efficient decompressive procedures at the foramen magnum based on neurological and MR findings.
对3例伴有基底凹陷和Chiari I畸形的脊髓空洞症患者进行了枕大孔前减压或后减压。使用术前和术后磁共振（MR）图像评估手术结果。2例因基底凹陷和扁桃体下疝导致颈髓前后联合受压的患者接受了枕下颅骨切除术、上颈椎椎板切除术和硬脑膜成形术，通过后路未进行任何硬膜内操作。1例因基底凹陷和斜坡轴角锐利导致颈髓前方明显受压的患者采用经口前路手术。术后，所有患者的脊髓空洞均持续缩小，扁平的小脑扁桃体变圆。2例患者的疝出扁桃体向上移动。所有患者在2至4年的随访期间症状均有改善。对于伴有基底凹陷和Chiari I畸形的脊髓空洞症，需要根据神经学和MR检查结果，在枕大孔处采取更有效的减压手术。
