Isu T, Iwasaki Y, Akino M, Abe H
Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan.
No Shinkei Geka. 1988;16(5 Suppl):631-8.
There is now a controversy about the methods of surgical treatment in syringomyelia associated with Chiari malformation. In this report, the authors emphasize that syringosubarachnoid shunt is effective as a surgical procedure or syringomyelia associated with Chiari malformation. From 1982 to 1986, 17 patients with syringomyelia associated with Chiari malformation were surgically treated. Seventeen patients underwent 22 operative procedures for syringomyelia. Syringosubarachnoid shunt was used in eighteen patients, foramen magnum decompression with syringosubarachnoid shunt in one, foramen magnum decompression with terminal syringostomy in one, terminal syringostomy in one, and ventriculoperitoneal shunt in one. The average postoperative follow up period was 2 years and 3 months, from 4 months to 4 years and 11 months. Thirteen out of 17 patients showed neurological improvement and 3 patients were neurologically unchanged. In one patient, the symptoms deteriorated. Syringosubarachnoid shunt is an effective therapeutic procedure for the patient with syringomyelia associated with Chiari malformation. We think that shunt malfunction by arachnoiditis after operation could be prevented by inserting the shunt tube into the subarachnoid space and closing the arachnoid membrane.
目前，关于 Chiari 畸形合并脊髓空洞症的外科治疗方法存在争议。在本报告中，作者强调脊髓蛛网膜下腔分流术作为 Chiari 畸形合并脊髓空洞症的一种外科手术是有效的。1982 年至 1986 年期间，17 例 Chiari 畸形合并脊髓空洞症患者接受了外科治疗。17 例患者因脊髓空洞症接受了 22 次手术。18 例患者采用了脊髓蛛网膜下腔分流术，1 例采用枕骨大孔减压术联合脊髓蛛网膜下腔分流术，1 例采用枕骨大孔减压术联合终丝脊髓造瘘术，1 例采用终丝脊髓造瘘术，1 例采用脑室腹腔分流术。术后平均随访期为 2 年 3 个月，从 4 个月至 4 年 11 个月。17 例患者中有 13 例神经功能改善，3 例神经功能无变化。1 例患者症状恶化。脊髓蛛网膜下腔分流术是治疗 Chiari 畸形合并脊髓空洞症患者的有效治疗方法。我们认为，通过将分流管插入蛛网膜下腔并封闭蛛网膜，可以预防术后蛛网膜炎导致的分流故障。
