Isu T, Iwasaki Y, Akino M, Abe H
Department of Neurosurgery, University of Hokkaido School of Medicine, Sapporo, Japan.
Acta Neurochir (Wien). 1990;107(3-4):152-60. doi: 10.1007/BF01405795.
The authors report the surgical results of 28 patients with syringomyelia associated with Chiari malformation (type 1). 28 patients underwent 34 operative procedures. Syringo-subarachnoid shunt was performed in 28 patients, foramen magnum decompression with syringo-subarachnoid shunt in three, ventriculo-peritoneal shunt in one, terminal syringostomy in one, and foramen magnum decompression with terminal syringostomy in one. In an average postoperative follow-up period of 3 years and 9 months ranging from one year to 7 years and one month, neurological symptoms and signs improved in 24 out of 28 patients (82%). Some improvement was noted in sensory deficit and motor weakness. In 3 patients, the symptoms did not change. In 3 patients whose symptoms were unchanged, preoperative studies demonstrated atrophy of the spinal cord, in which irreversible changes were shown. The symptoms deteriorated in one patient. In one patient whose symptoms increased 3 months after syringo-subarachnoid shunt, shunt insufficiency due to postoperative adhesive arachnoiditis was responsible for neurological deterioration. The authors propose that syringo-subarachnoid shunt is effective as a surgical procedure for syringomyelia associated with Chiari malformation (type 1) if the patient does not have symptoms due to Chiari malformation or has only mild signs and symptoms which do not require foramen magnum decompression, such as nystagmus or atrophy of sternocleidomastoid muscle.
作者报告了28例与Chiari畸形（1型）相关的脊髓空洞症患者的手术结果。28例患者接受了34次手术。28例行脊髓空洞 - 蛛网膜下腔分流术，3例行枕骨大孔减压并脊髓空洞 - 蛛网膜下腔分流术，1例行脑室 - 腹腔分流术，1例行终丝脊髓造瘘术，1例行枕骨大孔减压并终丝脊髓造瘘术。术后平均随访期为3年9个月，范围从1年至7年1个月，28例患者中有24例（82%）神经症状和体征改善。感觉障碍和运动无力有一定改善。3例患者症状未改变。在症状未改变的3例患者中，术前研究显示脊髓萎缩，存在不可逆改变。1例患者症状恶化。1例患者在脊髓空洞 - 蛛网膜下腔分流术后3个月症状加重，术后粘连性蛛网膜炎导致分流不足是神经功能恶化的原因。作者提出，如果患者没有Chiari畸形引起的症状或仅有不需要枕骨大孔减压的轻微体征和症状，如眼球震颤或胸锁乳突肌萎缩，脊髓空洞 - 蛛网膜下腔分流术作为治疗与Chiari畸形（1型）相关的脊髓空洞症的手术方法是有效的。
