Service of Pediatric Neurosurgery, Neurosurgical and Neurological Hospital P. Wertheimer , Lyon, France.
Neurol Sci. 2011 Dec;32 Suppl 3:S325-30. doi: 10.1007/s10072-011-0685-2.
The Chiari I malformation represents a complex disease and its pathophysiology is not completely understood and consequently different surgical procedures have been proposed in the literature. The use of MRI have increased the diagnosis of Chiari I malformation but generally the Chiari I is characterized by the herniation of tonsils at 5 mm below the plane of the occipital hole. The consequent disturbance of the CSF circulation at the level of the cranio-vertebral junction favors the occurrence of the syrinx between 20 and 70% of cases in pediatric series. Different surgical techniques have been proposed. We report two series of patients treated with the same surgical procedure except for the use of a Goretex dural patch in the second group with better clinical results. Our experience seems to confirm that the Chiari I malformation is a complex disease in which the impairment of the CSF circulation plays an important role to explain the severity of the clinical picture. The bone decompression and the restauration of the CSF circulation with a dural patch with Goretex seems to be effective for improving the clinical picture with good results.
Chiari I 畸形是一种复杂的疾病，其病理生理学尚未完全阐明，因此文献中提出了不同的手术方法。MRI 的应用增加了 Chiari I 畸形的诊断，但一般来说，Chiari I 畸形的特征是扁桃体在枕骨孔平面以下 5 毫米处疝出。颅颈交界处脑脊液循环的紊乱导致在儿科系列中 20%至 70%的病例中发生脊髓空洞症。已经提出了不同的手术技术。我们报告了两组接受相同手术治疗的患者，但第二组使用 Goretex 硬脑膜补片，临床效果更好。我们的经验似乎证实，Chiari I 畸形是一种复杂的疾病，脑脊液循环的障碍在解释临床表现的严重程度方面起着重要作用。骨减压和使用 Goretex 硬脑膜补片恢复脑脊液循环似乎可以有效改善临床症状，取得良好效果。
