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操作方法 - 寰枕减压术后采用“鼓皮”硬脑膜成形术治疗 Chiari 畸形。

How I do it - The "drum skin" duraplasty technique after foramen magnum decompression for Chiari malformations.

机构信息

Neurosurgery Department, ASST Cremona, Viale Concordia 1, 26100, Cremona, Italy.

Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.

出版信息

Acta Neurochir (Wien). 2023 Oct;165(10):3045-3050. doi: 10.1007/s00701-023-05576-9. Epub 2023 Apr 15.

DOI:10.1007/s00701-023-05576-9
PMID:37060375
Abstract

BACKGROUND

Chiari malformations are a spectrum of posterior cranial fossa anomalies characterized by herniation of the cerebellar tonsils through the foramen magnum. Surgery is the treatment of choice for selected patients with good postoperative outcomes.

METHODS

We describe foramen magnum decompression (FMD) with dural opening and a "drum skin" duraplasty technique.

CONCLUSIONS

In our experience, FMD with "drum skin" duraplasty is a safe and effective procedure, reducing the risk of CSF leakage and arachnoidal adhesions and yielding better long-term clinical and radiological outcomes than other traditional techniques.

摘要

背景

Chiari 畸形是一种后颅窝异常的谱系,其特征是小脑扁桃体通过枕骨大孔疝出。手术是治疗选择合适的患者的首选方法,术后效果良好。

方法

我们描述了硬脑膜开放和“鼓皮”硬脑膜成形术的枕骨大孔减压术(FMD)。

结论

根据我们的经验,FMD 联合“鼓皮”硬脑膜成形术是一种安全有效的手术方法,可降低 CSF 漏和蛛网膜粘连的风险,并产生比其他传统技术更好的长期临床和影像学结果。

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本文引用的文献

1
Foramen Magnum Decompression for Chiari Malformation Type 1: Is There a Superior Surgical Technique?后颅窝减压术治疗 Chiari 畸形 1 型:哪种手术技术更优?
World Neurosurg. 2023 Feb;170:e784-e790. doi: 10.1016/j.wneu.2022.11.119. Epub 2022 Nov 29.
2
Dura Management Strategies in the Surgical Treatment of Adult Chiari Type I Malformation: A Retrospective, Multicenter, Population-Based Parallel Cohort Case Series.成人 Chiari Ⅰ 型畸形手术治疗中的硬脑膜管理策略:一项回顾性、多中心、基于人群的平行队列病例系列研究。
Oper Neurosurg (Hagerstown). 2022 Oct 1;23(4):304-311. doi: 10.1227/ons.0000000000000340. Epub 2022 Aug 10.
3
Posterior Fossa Decompression and Duraplasty with and without Arachnoid Preservation for the Treatment of Adult Chiari Malformation Type 1: A Systematic Review and Meta-Analysis.
后颅窝减压和硬脑膜成形术联合或不联合蛛网膜保留治疗成人 Chiari 畸形 1 型:系统评价和荟萃分析。
World Neurosurg. 2021 Jul;151:e579-e598. doi: 10.1016/j.wneu.2021.04.082. Epub 2021 Apr 30.
4
Posterior fossa decompression with duraplasty in Chiari malformation type 1: a systematic review and meta-analysis.后颅窝减压并硬脑膜成形术治疗 Chiari 畸形 1 型:系统评价和荟萃分析。
Acta Neurochir (Wien). 2021 Jan;163(1):229-238. doi: 10.1007/s00701-020-04403-9. Epub 2020 Jun 23.
5
A Systematic Review of Chiari I Malformation: Techniques and Outcomes.Chiari I型畸形的系统评价:技术与结果
World Neurosurg. 2016 Apr;88:7-14. doi: 10.1016/j.wneu.2015.11.087. Epub 2015 Dec 28.
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Sudden onset of Chiari malformation type 1 in a young child after trauma.
Childs Nerv Syst. 2015 Sep;31(9):1589-94. doi: 10.1007/s00381-015-2736-0. Epub 2015 May 10.