| Objective:Discuss efficacy of small incision suboccipital decompression for Chiari malformation Type I.Corpus and Method:General material:From January 2009 to October 2010,17 patients suffered from chiari malformation type I treated in Neurosurgery Department of Qilu Hospital in Shandong Province, including 7 male patients (41.2%) and 11 female patients (58.8%), age 14-67 year-old, average 40.2-year-old.16 patients take the limb numbness as the main symptoms (94%); 10 patients have the feel pain and temperature sensation decreased mainly in patients (58.8%); 4 patients occurred with ataxia (23.5%); 2 patients have the symptoms of cranial nerve damage such as swallowing difficulties, drinking cough, etc. (11.8%); 1 patient (14-year-old, male) is asymptomatic (5.9%).MRI shows that there are 4 patients with simple tonsillar hernia malformation,13 patients merged with syringomyelia,5 patients accompanied by basilar invagination and 1 patients with atlanto-occipital fusion. We make retrospective analysis of 16 patients with chiari malformation type I (which is merged the symptoms of syringomyelia) of them who had been treated with small incision suboccipital decompression.Surgical methods:Specific surgical procedures are as follows:After being anesthetized, the patient takes the prone position and head is fixed, Mark on the 3cm of Straight incision from posteri median incision external occipital protuberance to spinous process of C2。Make the department of occipital scales, atlas and axis to be visible. Grind about 2 * 2cm of bone which is in the posterior margin of the foramen magnum, grind posterior arch of the atlas and grind 1/2 spinous and about 2.5 cm of lamina in the axis. Whether release the atlantooccipital ligament to ease the constraints on the dura depends on the thickness of atlantooccipital. During the surgery, dura is not open in order to prevent intracranial infection to some extent, (among of them, one 67-year-old woman did not been treated by surgery because of poor tolerance caused by lung infection; one 27-year-old woman merged with basilarinvagination was treated with microsurgical odentoidectomy via transoral transpharyngeal approach at first stage, then was treated with small incision suboccipital decompression.)Findings:Clinical symptoms of 16 patients treated with surgery have significantly improved. Syringomyelia can also reduce or even disappear in various degrees.Conclusion:Small incision suboccipital decompression can make cervical medullary decompression, recover cerebrospinal fluid circulation, relieve clinical symptoms effectively, have a good effect on the treatment of syringomyelia, is relatively simple and effective way to treat chiari malformation type I. |
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