Application of posterior fossa decompression and reconstruction in adults with the Chiari I malformation
10.3760/cma.j.issn.1001-2036.2015.01.013
- VernacularTitle:颅后窝结构重建在成人Chiari Ⅰ型畸形手术中的应用
- Author:
Changhe PANG
;
Wei DU
;
Jiang LONG
;
Laijun SONG
- Publication Type:Journal Article
- Keywords:
Chiari Ⅰ malformation;
Posterior fossa;
Reconstruction;
Microsurgical technique
- From:
Chinese Journal of Microsurgery
2015;38(1):52-55
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the results of surgically treated Chiari Ⅰ malformation (CMI) with posterior fossa decompression and reconstruction techniques.Methods Sixty-nine patients with CMI malformation underwent posterior fossa reconstruction.The operation involes dissection soft tissue from the suboccipital region,decompression by removing the posterior rim of the foramen magnum.Then the dura was opened widely with Y shape,as it often acts as a constricting band,particularly at the level of the foramen magnum.After dissecting the subarachnoid adhesions in cisterna magna with microsurgery techniques,dissecting part of the tonsillar hernia,opening the foramen of Magendie into the 4th ventricle and closing the dura using artificial dura mater,cranial bone flaps was repositioned centrally along the inferior edge of the craniectomy defect,so as to support the dura over the cerebellar hemispheres.Results Until the final follow-up,the clinical symptoms were improved in 56 patients,3 had recurrence after 1 year postoperatived,4 had recurrenced after 2 years postoperatived,and 87.5％ patients were stable.The patients took followed-up MRI at least once form 3 months to 6 months,and 13 cases were lost.One case with tension pneumocephalus,and 5 cases with subcutaneous effusion and cerebro-spinal fluid (CSF) incision leakage.There were no death and disability.Thirty-one cases favors the development of syringomyelia,6 showed the stable of syringomyelia,and 2 had an increased size of the cavity.Conclusion Dissecting the subarachnoid adhesions in cisterna magna with microsurgery techniques,dissecting part of the tonsillar hernia,opening the foramen of Magendie into the 4th ventrica,and circulation of CSF pathway are important to improve thetherapeutic effect of CMI.It is also very important to decompression with small cranial bone flaps,closing the dura using artificial dura mater under no tension,and bone structure reconstruction in the clinical practice.
