Tyagi Gaurav, Uppar Alok Mohan, Pruthi Nupur, Shukla Dhaval
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, II Floor, Faculty Block, Hosur Road, Bangalore, 560029, India.
Acta Neurochir (Wien). 2023 Mar;165(3):767-770. doi: 10.1007/s00701-023-05490-0. Epub 2023 Jan 10.
Chiari malformation type 1 has been traditionally treated with foramen magnum decompression and C1 arch excision with or without duroplasty depending on the surgeon's preference. Each of the various surgical modifications has its advantages and disadvantages.
We describe a minimally invasive tubular retractor-based approach to achieve bony decompression in these cases. We have had good results comparable to the open approach.
Strict orientation to the midline using soft tissue landmarks in between the muscles and bony landmarks in the deeper planes is important to achieve good surgical results. Operative time decreases with expertise and is comparable to the open technique. Minimal blood loss and decreased hospital stay and an excellent cosmetic scar make this procedure more appealing.
传统上，1型Chiari畸形的治疗方法是枕骨大孔减压术以及根据外科医生的偏好决定是否进行硬脊膜成形术的C1椎弓切除术。各种手术改良方法都有其优缺点。
我们描述了一种基于微创管状牵开器的方法，用于在这些病例中实现骨性减压。我们取得了与开放手术相当的良好效果。
在肌肉间的软组织标志和更深层面的骨性标志之间严格以中线为导向，对于取得良好的手术效果很重要。手术时间会随着经验的积累而减少，并且与开放技术相当。出血量极少、住院时间缩短以及美观的瘢痕使得该手术更具吸引力。
