Clinical Treatment Of Chiari Type Ⅰ Malformation With Syringomyelia

Objective Chiari type I malformations The caudal cerebellar tonsils are embedded in the cervical canal and occipital foramina.The medulla oblongata and cervical cord are subject to pressure and increased intracranial pressure.They are often associated with syringomyelia and other deformities at the craniocervical junction,causing a series of The clinical symptoms.There are many ways in the surgical treatment of this disease,the efficacy is different,there is no conclusion.In this study,we retrospectively analyzed the clinical efficacy of the two commonly used surgical methods at home and abroad,including simple posterior decompression of the skull(external decompression)and suboccipital decompression + reconstruction of the occipital pool(internal decompression.)to reduce medical costs and improve quality of life.Method The clinical data of 62 patients with Chiari type I malformation with syringomyelia admitted to our department from 2014 to 2017 were retrospectively analyzed and divided into two groups according to different surgical methods.A total of 22 patients in the posterior degenerative decompression group were included in the control group,and 40 patients in the suboccipital decompression plus occipital remodeling group were included in the study group.Evaluation criteria:(1)compare the operation time,blood loss,and length of stay of the two operations;(2)compare the incidence of early complications and the improvement of recent symptoms after the two operations;(3)follow-up of all patients From 3 months to 1 year,according to the Tator score,the total effective rate at 6 months and 1 year after surgery was evaluated;(4)The cerebellar tonsil retraction and syringomyelia changes after the two operations were compared.Results(1)There was no significant difference in the volume of blood loss between the simple posterior cranial decompression group and the suboccipital decompression plus occipital remodeling group(P>0.05),but the operation of the posterior degenerative decompression group was simple.The time and postoperative hospital stay were significantly shorter than those in the suboccipital decompression plus occipital remodeling group,and the difference was statistically significant(P<0.05).(2)The incidence of total complications in the near future was significantly higher in the suboccipital decompression plus occipital remodeling group than in the simple posterior decompression decompression group(P<0.05).The improvement rate was not statistically significant(P>0.05),and the two methods had similar effects in the near future.(3)The total effective rate was evaluated according to the Tator score at 6 months and 1 year after surgery.The total effective rate of the suboccipital decompression plus occipital remodeling group was significantly higher than that of the simple posterior decompression decompression group,and the follow-up time was longer.The more effective the suboccipital decompression plus occipital remodeling group is.(4)5 out of 22 patients in the posterior degenerative decompression group only regressed to the occipital large hole plane,while 40 patients in the suboccipital decompression plus occipital remodeling group regressed to the occipital large hole plane.There were 26 cases with significant differences(P<0.05).In the simple posterior degenerative decompression group,there were 10 cases of the reduction of the syrinx cavities in the 22 patients,and in the 40 cases of the 34 cases of the suboccipital decompression plus occipital remodeling group,the syringomyelia was significantly reduced,and the improvement of syringomyelia was obvious in both groups.Difference(P<0.05).Conclusion Pure post-cranial decompression and sub-occipital decompression plus occipital remodeling have good clinical efficacy,although the short-term complications after surgery are due to the specificity of the surgical approach.Slightly higher than the simple posterior concave decompression surgery,but from the perspective of long-term efficacy,the suboccipital decompression plus occipital pool reconstruction is more advantageous,the overall improvement rate is higher,it is worth promoting.