Villa Alessandro, Imperato Alessia, Maugeri Rosario, Visocchi Massimiliano, Iacopino Domenico Gerardo, Francaviglia Natale
Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy.
Division of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy.
Acta Neurochir Suppl. 2019;125:125-131. doi: 10.1007/978-3-319-62515-7_18.
The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year experience, describing our technique and critically evaluating the clinical results.
Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39.2 years) underwent posterior fossa decompression for Chiari malformation type I. Their clinical complaints included headache, nuchalgia, upper limb weakness or numbness, instability, dizziness and diplopia. Syringomyelia was present in 12 patients (48%). Suboccipital craniectomy was completed in all cases with C1 laminectomy and shrinkage of the cerebellar tonsils by bipolar coagulation; duraplasty was performed with a suturable dura substitute.
Gratifying results were observed in our series. Symptoms and signs were resolved in 52% of patients, and 20% of patients had an improvement in their preoperative deficits. The symptoms of six patients (24%) were essentially unchanged, and one patient (4%) deteriorated despite undergoing surgery. Generally, patients with syringomyelia on magnetic resonance imaging (MRI) showed less symptomatic improvement after surgery. The syrinx disappeared in seven of 12 patients, and complications occurred in three patients (12%).
Cerebellar tonsil reduction and restoration of cerebrospinal fluid (CSF) circulation provided clinical improvement and a stable reduction in the syrinx size in the vast majority of treated patients, with a low rate of complications.
I型Chiari畸形患者的症状和影像学表现多样，这使得手术指征和技术方式都存在争议。我们报告了我们5年的经验，描述了我们的技术并对临床结果进行了批判性评估。
2012年至2016年期间，25例患者（15例女性和10例男性；平均年龄39.2岁）接受了I型Chiari畸形的后颅窝减压术。他们的临床症状包括头痛、颈部疼痛、上肢无力或麻木、共济失调、头晕和复视。12例患者（48%）存在脊髓空洞症。所有病例均完成枕下颅骨切除术并进行C1椎板切除术，通过双极电凝使小脑扁桃体缩小；使用可缝合的硬脑膜替代物进行硬脑膜成形术。
我们的系列观察到了令人满意的结果。52%的患者症状和体征得到缓解，20%的患者术前缺陷有所改善。6例患者（24%）的症状基本未变，1例患者（4%）尽管接受了手术但病情恶化。一般来说，磁共振成像（MRI）显示有脊髓空洞症的患者术后症状改善较少。12例患者中有7例脊髓空洞消失，3例患者（12%）出现并发症。
小脑扁桃体缩小和脑脊液（CSF）循环恢复使绝大多数接受治疗的患者临床症状改善，脊髓空洞大小稳定缩小，并发症发生率低。
