Analysis Of The Curative Effect Of Chiari Malformation Type Ⅰ Combined With Syringomyelia

Objective:Arnold-Chiari malformation(ACM)is a congenital disease in which the cerebellar tonsils herniate into the spinal canal,often with syringomyelia(SM).25 cases of Chiari malformation combined with syringomyelia treated in our hospital are evaluated for postoperative clinical symptoms and signs and imaging improvement.The curative effect of type I malformation combined with syringomyelia is to provide a reference for clinical treatment.Methods:From March 2014 to December 2018,25 patients with Chiari malformation combined with syringomyelia were admitted to the neurosurgery of our hospital,including 11 males and 14 females,aged 4 to 58 Years old(average age 34.3 years),course of disease 0.1 to 20 years(average 4.3 years).All patients had completed MRI evaluation before operation,and 25 patients had lower hernias of cerebellar tonsils.The degree of lower hernias ranged from 4 to 20 mm,with an average of 11.3mm.All of them were combined with different segments of the spinal cord cavity,and the occipital cistern disappeared.Evaluation and analysis of the changes in clinical symptoms and signs and imaging changes of patients before and after the operation at different time periods,and to explore the effect of inferior hernia cerebellar tonsillectomy and posterior cranial fossa decompression and dural expansion and repair on patients with Chiari type deformity.Results:All the 25 patients in this group were treated by tonsillectomy with cerebellar tonsillectomy and posterior cranial fossa decompression.After 3 months and 3 years of follow-up,the clinical symptoms of the patients were improved;14 patients(56%)had improved clinical symptoms and 11 patients(44%)were stable after surgery;15 patients(60%)with improved clinical symptoms,5 patients with stable(20%),and 5 patients with aggravated 5(20%)were followed up for 3 years;CCOS scores were followed up for 3 months and 3 years after operation;There were 14 cases(56%)with a monthly score of 13-16 points;8 cases(32%)with a score of 10-12 points;3 cases(12%)with a score of 4-9 points;There were 14 cases(56%)from 13 to 16;6 cases(24%)from 10 to 12 points;5 cases(20%)from 4 to 9 points after surgery;the average CCOS score was 12.2 at 3 months after surgery CCOS average score of 12.16 points at 3 years postoperatively;imaging changes at 1 month and 1 year postoperative follow-up:found 2 cases of syringomyelia contraction at 1 month postoperatively;23 cases had no change;postoperative In 1 year,9 cases of syringomyelia were reduced,15 cases were unchanged,and 1 case was enlarged;2 cases of cerebellar tonsils removed after surgery were moved down again.Conclusion:Inferior hernia cerebellar tonsilectomy and posterior cranial fossa decompression and plastic epidural angioplasty is a safe and effective surgical method for the treatment of Chiari type I deformity combined with syringomyelia;the time for the improvement of the symptoms of Chiari type I deformity with syringomyelia is basically within 3 months after surgery;This operation has a certain effect on patients with syringomyelia.During the follow-up period,the syringomyelia gradually improved with time.