Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China.
Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2020 Dec;144:e178-e188. doi: 10.1016/j.wneu.2020.08.068. Epub 2020 Aug 15.
This article discusses the procedure of foramina magnum and Magendie dredging, summarizing the pathologic changes in the intradural region of the craniocervical junction in patients with syringomyelia and the pathophysiologic mechanism of cerebrospinal fluid (CSF) circulation obstruction.
Clinical data from 50 adult patients with syringomyelia treated at Xuanwu Hospital from July 2018 to January 2019 were collected and retrospectively analyzed. All operations were performed with foramina magnum and Magendie dredging, and all intradural factors that may have induced the obstruction of CSF circulation were recorded.
Intradural pathology was found in all patients. The pathologic changes that may have caused obstruction of the CSF circulation include tonsil occupying the foramen magnum and overlying foramen of Magendie in 88% (44/50), intertonsillar arachnoid adhesions in 36% (18/50), tonsil to medulla arachnoid adhesions in 18% (9/50), medialized tonsils in 70% (35/50), vermian branch of posterior inferior cerebellar artery in 22% (11/50), arachnoid veil in 16% (8/50), cisterna magna cyst in 4% (2/50), and tonsil to dura mater arachnoid adhesions in 8% (4/50). Mean duration of follow-up was 13.3 months. The long-term effective rate was 96.0%. Postoperative magnetic resonance imaging revealed that the size of the syringomyelia was reduced or completely resolved in 88% of patients. The mean preoperative Japanese Orthopaedic Association score was 12.9 ± 3.1, which improved to 14.7 ± 3.2 (P < 0.05) at last clinical follow-up.
Intradural pathology that causes CSF circulation obstruction exists in many forms. Relieving the obstruction of the foramen magnum and foramen of Magendie is key to surgical treatment.
本文讨论了枕骨大孔和 Magendie 疏通术的操作过程，总结了脊髓空洞症患者颅颈交界区硬脊膜内的病理变化及脑脊液（CSF）循环阻塞的病理生理机制。
回顾性分析 2018 年 7 月至 2019 年 1 月宣武医院收治的 50 例成人脊髓空洞症患者的临床资料，所有患者均采用枕骨大孔和 Magendie 疏通术进行治疗，并记录所有可能导致 CSF 循环阻塞的硬脊膜内因素。
所有患者均存在硬脊膜内病变。可能导致 CSF 循环阻塞的病理变化包括：88%（44/50）的扁桃体占据枕骨大孔和 Magendie 孔上方，36%（18/50）的扁桃体间蛛网膜粘连，18%（9/50）的扁桃体与延髓蛛网膜粘连，70%（35/50）的扁桃体向内侧移位，22%（11/50）的小脑后下动脉蚓支，16%（8/50）的蛛网膜帆，4%（2/50）的小脑延髓池囊肿，8%（4/50）的扁桃体与硬脑膜蛛网膜粘连。平均随访时间为 13.3 个月。长期有效率为 96.0%。术后磁共振成像显示 88%的患者脊髓空洞症的大小缩小或完全消失。术前日本矫形协会评分平均为 12.9±3.1，末次临床随访时改善至 14.7±3.2（P＜0.05）。
存在多种形式的导致 CSF 循环阻塞的硬脊膜内病变。缓解枕骨大孔和 Magendie 孔的阻塞是手术治疗的关键。
