Sugawara Atsushi, Isu Toyohiko, Kim Kyongsong, Matsumoto Ryoji, Isobe Masanori, Ogasawara Kuniaki
Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
J Nippon Med Sch. 2010 Aug;77(4):221-5. doi: 10.1272/jnms.77.221.
A 31-year-old woman presented with worsening numbness and pain in the arms and chest. Neurological findings at admission were decreased pain sensation and temperature sensation in the arms and chest. Magnetic resonance demonstrated a large cervical syrinx from the level of C4 to Th4 associated with Chiari I malformation. Occipital craniectomy and C1 laminectomy were performed for foramen magnum decompression. Intraoperative ultrasonography, performed after removal of the outer membrane of the dura mater at the level of the foramen magnum, revealed insufficient decompression. Therefore, the dura mater was completely opened and duraplasty was performed with a polyglycolic acid patch and fibrin glue. Sufficient decompression was thus achieved. The neurological symptoms and signs improved within the first postoperative month, and magnetic resonance showed a decrease in the size of the syrinx and no cerebrospinal fluid leakage. In patients undergoing foramen magnum decompression with duraplasty, the use of a polyglycolic acid patch and fibrin glue renders suturing unnecessary and avoids the common complications associated with suture duraplasty.
一名31岁女性因手臂和胸部麻木及疼痛加重前来就诊。入院时神经系统检查发现手臂和胸部痛觉及温度觉减退。磁共振成像显示从C4至Th4水平有一个巨大的颈髓空洞症，伴有Chiari I畸形。行枕下颅骨切除术和C1椎板切除术以进行枕大孔减压。在枕大孔水平切除硬脑膜外层后进行术中超声检查，发现减压不充分。因此，完全打开硬脑膜，并用聚乙醇酸补片和纤维蛋白胶进行硬脑膜成形术。从而实现了充分减压。术后第一个月内神经症状和体征有所改善，磁共振成像显示脊髓空洞症大小减小且无脑脊液漏。在接受枕大孔减压并进行硬脑膜成形术的患者中，使用聚乙醇酸补片和纤维蛋白胶无需缝合，避免了与缝合硬脑膜成形术相关的常见并发症。
