Rhoton A L
J Neurosurg. 1976 Nov;45(5):473-83. doi: 10.3171/jns.1976.45.5.0473.
Microsurgical exploration of 15 adults with Arnold-Chiari malformation with and without hydromyelia using 3 to 20 X magnification has led to the following conclusions. Hydromyelia, associated with Arnold-Chiari malformation, is a progressive mechanical disorder that causes spinal cord deficits by pressure distention of the cord. Arnold-Chiari malformation causes slowly or suddenly progressive bulbar dysfunction by impaction of the malformation in the foramen magnum. Decompression of both can be achieved by a suboccipital carniectomy, upper cervical laminectomy, establishing an outlet from the fourth ventricle, and opening the distended cord in the thinnest exposed area, which is usually along the dorsal root entry zone. If Pantopaque myelography in patients in the supine position shows the Arnold-Chiari malformation, hydromyelia can be established as a cause of central cord deficit even if myelography shows the cord size to be normal. Syringomyelia, traditionally considered a degenerative disease, is a less common cause of a slowly progressive central cord deficit than either hydromyelia or intramedullary tumor.
对15例患有或未患有脊髓空洞症的阿诺德 - 基亚里畸形成年患者进行3至20倍放大的显微外科探查，得出了以下结论。与阿诺德 - 基亚里畸形相关的脊髓空洞症是一种进行性机械性疾病，通过脊髓的压力扩张导致脊髓功能缺损。阿诺德 - 基亚里畸形通过畸形压迫枕骨大孔导致缓慢或突然进展的延髓功能障碍。两者的减压可通过枕下颅骨切除术、上颈椎椎板切除术、建立第四脑室出口以及在最薄的暴露区域（通常沿着背根进入区）打开扩张的脊髓来实现。如果仰卧位患者的碘苯酯脊髓造影显示阿诺德 - 基亚里畸形，即使脊髓造影显示脊髓大小正常，脊髓空洞症也可被确定为中央脊髓功能缺损的原因。传统上被认为是一种退行性疾病的脊髓空洞症，与脊髓空洞症或髓内肿瘤相比，是缓慢进展的中央脊髓功能缺损的较不常见原因。
