Chiari I型畸形的争议
Controversies in Chiari I malformations.
作者信息
Baisden Jamie
机构信息
Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, WI, USA.
出版信息
Surg Neurol Int. 2012;3(Suppl 3):S232-7. doi: 10.4103/2152-7806.98580. Epub 2012 Jul 17.
BACKGROUND
The diagnosis and management of Chiari I malformations (CMI) remains controversial, particularly since it is often an incidental finding on cervical MR scans performed for neck pain and/or headaches. Recently, some surgeons "over-operated" on asymptomatic patients with Chiari I malformations, or even on those without the requisite radiographic diagnostic features for Chiari I malformations: unfortunately, only a subset were admonished for indiscriminate surgery. Nevertheless, when this hindbrain malformation is truly symptomatic, contributing to impaired cerebrospinal fluid (CSF) circulation, various valid surgical management strategies may be adopted.
METHODS
This review focuses on the current literature regarding the clinical presentation, diagnosis, and surgical management of Chiari I malformation. Variations in the surgical technique are also presented and critiqued.
RESULTS
The recommended treatment for Chiari I malformations I consists of decompressive suboccipital craniectomy and duroplasty when abnormal cine-flow MRI is observed preoperatively and blockage of CSF flow persists intraoperatively despite bony decompression.
CONCLUSIONS
Controversy continues regarding the optimal surgical technique to address Chiari malformations I. Proper diagnostic studies and patient selection are needed to optimize patient outcomes, while avoiding unnecessary surgical procedures.
背景
Chiari I 型畸形（CMI）的诊断和治疗仍存在争议，尤其是因为它常在因颈部疼痛和/或头痛而进行的颈椎磁共振扫描中偶然发现。最近，一些外科医生对无症状的 Chiari I 型畸形患者甚至对那些没有 Chiari I 型畸形必要影像学诊断特征的患者进行了“过度手术”；不幸的是，只有一部分人因手术不当而受到告诫。然而，当这种后脑畸形真正出现症状并导致脑脊液（CSF）循环受损时，可以采用各种有效的手术治疗策略。
方法
本综述重点关注关于 Chiari I 型畸形的临床表现、诊断和手术治疗的当前文献。还介绍并批评了手术技术的差异。
结果
当术前观察到异常的电影流动磁共振成像且尽管进行了骨性减压但术中脑脊液流动仍持续受阻时，Chiari I 型畸形的推荐治疗方法包括枕下减压颅骨切除术和硬脑膜成形术。
结论
关于治疗 Chiari I 型畸形的最佳手术技术仍存在争议。需要进行适当的诊断研究和患者选择，以优化患者预后，同时避免不必要的手术程序。
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