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目的探讨Chiari畸形并脊髓空洞手术中,下疝的小脑扁桃体下舌分型与切除的标准。方法术中显微镜下观察32例下疝的小脑扁桃体压迫延髓的部位及其关系,结合MRI,提出下疝的小脑扁桃体分型,并根据分型切除小脑扁桃体下舌,切开脊髓中央管开口隔膜或活瓣,恢复第四脑室内脑脊液循环通畅。结果小脑扁桃体分型:①根据压迫部位分为:后方型27例,侧方型4例,侧前方型1例;②根据小脑扁桃体下疝程度分为:单侧压迫型11例,双侧压迫型21例。术后随访28例,MRI检查示下疝的小脑扁桃体均消失,第四脑室内脑脊液循环通畅,脊髓空洞明显缩小和消失;术后病人临床症状大多改善。结论下疝的小脑扁桃体根据其分型并切除,可为手术治疗Chiari畸形并脊髓空洞提供标准及依据。。
Objective To investigate the criteria for the classification and resection of the inferior tongue of the cerebellar tonsil in Chiari deformity and syringomyelia. Methods The microsurgical observation of the parts and their relationship of medulla oblongata in 32 cases of inferior cerebellar tonsil under the microscope was performed. The classification of cerebellar tonsils under the hernia was proposed by MRI. According to the classification, the inferior cerebellar tonsils were excised and the spinal canal opened Or flap, to restore smooth circulation of cerebrospinal fluid in the fourth ventricle. Results Cerebellar tonsillar classification: According to the compression site is divided into: 27 cases of posterior, 4 cases of lateral, lateral anterior type in 1 case; ② According to the degree of cerebellar tonsillar hernia divided into: unilateral oppression in 11 cases, bilateral oppression Type 21 cases. Twenty-eight patients were followed up. MRI showed that the cerebellar tonsils of hernias disappeared, the circulation of cerebrospinal fluid in the fourth ventricle was unobstructed, the syringomyelia conspicuously reduced and disappeared, and the clinical symptoms of the patients were mostly improved. Conclusion The hernia of the cerebellar tonsils according to their classification and excision can provide the standard and basis for the surgical treatment of Chiari deformity and syringomyelia. .