Clinical Application Of Minimally Invasive Surgery In The Treatment Of Chiari(Type?) Malformation

Part? Volume measurement research of cisterna magna in Chiari malformation(type ?)Background Most scholars think that the cause of Chiari malformation(type ?)is that the posterior cranial fossa tissues(mostly bony structures)develop abnormally,resulting in small posterior fossa size.Then the herniation of the cerebellar tonsils is induced and the volume of the cisterna magna is reduced or disappeared,which impedes the circulation of the cerebrospinal fluid.Therefore,the enlargement of the posterior fossa volume,the reconstruction of the cisterna magna,and the removal of the obstruction of the foramen magnum leads to the recovery of cerebrospinal fluid circulation,which is the key to the solution of this disease.Object The pathogenesis of Chiari malformation(type ?)is further revealed by measuring the volume of the normal cisterna magna.Meanwhile,there are researches about the volume of cisterna magna,the volume of foramen magnum and the measurement of brain in foramen magnum in patients with Chiari malformation(type ?)associated with syringomyelia before and after operation,which provides quantitative support for the size and shape of the reconstructed cisterna magna in minimally invasive surgery including reshaping and repairing the part and shape of hernia cerebellar tonsils.Methods 1.Illustrated samples all use 3.0T superconducting MR imager and head and neck 20 channel phased array coil.The scanning sequence uses 3D-SPC sequence to import the DICOM image of the sample head MRI into the Mimics software to generate the STL file.According to the cisterna magna limits predetermined,after drawing fixed range,the software generates the 3D image of cisterna magna automatically using the method of measuring regional automatic growth volume and the 3D imaging software of the cisterna magna is built,and the measurement tools are used to generate the results automatically.DICOM images of the head and neck MRI within six months before and after operation are added to the Mimics software to generate the STL file to describe the volume of the cisterna magna,the volume of the foramen magnum in the cisterna magna before and after the operation,which are measured and compared with the measured figures,but also with the normal preoperative,postoperative cisterna magna volume,the volume of foramen magnum and the measurement of brain in foramen magnum.Results 1.This study uses SPSS21.1 statistical software to measure among the normal population consisting of 31 males and 30 females.The statistical analysis shows the volume of cisterna magna,the volume of foramen magnum and the proportion of brain in occipital foramen are not statistically significant between males and females.Nor are Chiari malformation complicated with syringomyelia(type?)in patients with 33 males and 32 females before and after the operation.2.Patients' foramen magnum volume is 80.08±14.86cm3,while the figure in the normal group is 95.01±11.06cm3.According to the paired t-test,t=6.361,P =0.017<0.05.Compared with the normal group,the volume of the foramen magnum in patients is smaller,and the difference is statistically significant.3.The preoperative volume of the cisterna magna is 2.46±1.89 cm3,while after the operation,the volume is 5.50±1.9 cm3.According to the paired t-test,t=24.595,P =0.000<0,05.There is significant difference in statistics between the preoperative volume of the cisterna magna,and the cisterna magna enlarges obviously after operation.4.The preoperative volume of the cisterna magna is 2.46±1.89 cm3,while the normal volume is 9.71±3.54 cm3.According to the paired t-test,t=-14.46,P =0.000<0.05.Compared with the normal group,the preoperative volume of the cisterna magna is smaller,which is different significantly.5.Before operation,the brain proportion is 96.97±2.04%,while after operation,the figure is 93.13±2.01%.According to the paired t-test,t=23.096,P =0.000<0,05.Compared with the preoperative brain ratio,the postoperative brain proportion decreases obviously,which is statistically significant.6.The preoperative brain proportion is 96.97±2.04%,while the brain ratio in normal group is 89.85±3.44%.According to the paired t-test,t=14.25,P =0.001<0,05.Compared with the normal group,the preoperative brain proportion is higher,which is different significantly.7.After the operation,the volume of the cisterna magna is 5.50±1.99 cm3,while the figure in the normal group is 9.70±3.5 cm3.According to the paired t-test,t=8.298,P =0.000<0,05.The postoperative volume of the cisterna magna is closed to the volume in normal group,which is statistically significant.8.After the operation,the brain proportion in occipital foramen is 93.12±2.00%,while the figure in the normal group is 89.85±3.44%.According to the paired t-test,t=6.585,P =0.001<0.05.The postoperative brain ratio in occipital foramen is closed to the figure in normal group,which is statistically significant.Conclusion 1.The volume of cisterna magna,the volume of foramen magnum and the proportion of brain in occipital foramen are not statistically significant between males and females.2.The volume of foramen magnum and the cisterna magna in patients with Chiari malformation(type 1)complicated with syringomyelia is much smaller than that of normal population and the cisterna magna is occupied by the cerebella tonsil herniation,and the brain ratio in occipital foramen is much higher than that of normal population.After minimally invasive surgery,the volume of the reconstructed ciaterna magna increases significantly compared with the volume before operation.3.In minimally invasive surgery,the size and shape of cisterna magna,the shape of the cerebella tonsils,the volume of foramen magnum and brain ratio in occipital foramen are used to conduct how much this hernia should be reshaped and repaired,and assess whether the cisterna magna reconstruction is up to expectations and provide quantitative support.Part2 The clinical efficacy study of Minimally Invasive Subpial Tonsilectomy(MIST)and reconstruction of the cisterna magna in the treatment of Chiari malformation(type ?)complicated with syringomyelia.Object Through Minimally Invasive Subpial Tonsilectomy(MIST)and reconstruction of the cisterna magna,the pia deformity of cerebellar tonsillar herniation is removed,the rest is reshaped and repaired,the cisterna magna is rebuilt,which can improve the deformity of posterior fossa,restore cerebrospinal fluid circulation,treat the disease of Chiari malformation(type?)complicated with syringomyelia so that it can achieve good surgical results and reduce complications.Methods 1.Between January 2014 and June 2015,130 patients meet the inclusion criteria.Under the intraoperative ultrasound monitoring,the minimally invasive subpial cerebella tonsil herniation resection and reconstruction of the cisterna magna is used to treat the disease of Chiari malformation(type ?)complicated with syringomyelia.2.The scoring scale(CCOS)is used to assess four aspects of pain symptoms,non pain symptoms,functional and surgical complications,which combines with the traditional evaluation method of “improving”,“unchanging” and “worsening” to evaluate the surgical efficacy of the experimental group and the literature group and the historical control group.3.SPSS21.0statistical software is used to analyze,and the measurement data is expressed by mean± standard deviation(x ± s).All the data is checked by homogeneity of variance before statistical treatment,which meets the requirements of t-test.Two independent samples'-test and paired test are used for comparison between groups.Enumeration data is expressed by frequency and percentage,and x2 test and Fisher exact probability test are used to compare between groups.P<0.05 is used as a statistically significant criterion.Results There are 130 cases of minimally invasive surgery,167 cases of historical control group,and 378 cases of literature group.1..Evaluated by Chicago Chiari Outcome Scale(CCOS)scores,the minimally invasive group is good in 127 cases,the score is greater than or equal to 11 points,poor in 3 cases,scoring 4-10 points,and the improvement rate is 97.7%.while the improvement rate in historical control group is 82.2 %.Tested by Fisher exact probability method,P=0.032 < 0.05 indicates that compared with the historical control group,the minimally invasive group has better curative effect,and the difference is statistically significant.2.Evaluated by traditional methods,compared with the 378 cases in the literature group,123 cases in the minimally invasive group are good,unchanged in 7 cases,and the improvement rate is 94.6%.While the improvement rate in the literature group is 77.8%.Tested by Fisher exact probability method,P=0.000<0.001 indicates that compared with the literature group,the minimally invasive group has better curative effect,and the difference is statistically significant.3.Compared with the MRI of 6 month after operation,the syringomyelia in 130 cases is reduced to some extent.Some patients disappear and the symptoms are relieved.Conclusion 1.The Minimally Invasive Subpial Tonsilectomy MIST and the reconstruction of citerna magna is a modified method of operation for the treatment of Chiari malformation(type ?)complicated with syringomyelia.The curative effect is obvious and the complications are few.2.The results measured by B ultrasonic during the operation are compared with the volume of citerna magna in normal population preliminary.The extent of the blockage in the cisterna magna is generally assessed to guide the clinician in the treatment of the tonsillar herniation and the repair of the cisterna magna.3.Compared with the traditional surgery,this method,besides the small incision,mild postoperative response and less complications,emphasizes the reconstruction and repair of the cerebellar tonsil and the reconstruction of the ciaterna magna and the circulation of cerebrospinal fluid.