Goel A, Bhatjiwale M, Desai K
Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Bombay, India.
J Neurosurg. 1998 Jun;88(6):962-8. doi: 10.3171/jns.1998.88.6.0962.
The authors analyzed the cases of 190 patients with basilar invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure.
Depending on the association with Chiari malformation, the anomaly of basilar invagination was classified into two groups. Eighty-eight patients who had basilar invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both basilar invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II.
Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. After surgical decompression, a fixation procedure was found to be necessary in most Group I cases, but only in a small minority of Group II cases.
作者分析了190例根据张伯伦1939年制定的标准诊断为基底凹陷症的患者病例，以评估合适的手术方法。
根据是否合并Chiari畸形，将基底凹陷症异常分为两组。88例有基底凹陷但无合并Chiari畸形的患者被归入第一组；其余既有基底凹陷又有Chiari畸形的患者被归入第二组。观察到主要病理特征为第一组因齿状突压迫导致直接脑干受压，第二组为后颅窝容积减小。
尽管两组脑干均有前凹，但经口手术是第一组患者最合适的手术方法，而枕骨大孔减压术对第二组患者合适。手术减压后，发现大多数第一组病例需要进行固定手术，但第二组只有少数病例需要。
