The Surgical Treatment Of Chiari Malformation

Objective:To discuss the indications of different surgical manipulations and microsurgical techniques to the patients of Chiari malformation,to analyze the disparations of therapeutic effects,postoperative complications of different surgical managements and to improve the recovery rate of the patients.Methods:80 diagnosed cases by MRI as Chiari malformation typeâ… andâ…¡who underwent surgical managements from January 2007 to March 2010 from the department of neurosurgery of the 2nd Xiangya hospital were included in this study.Their datas of clinical manifestation,imaging,operational modes,therapeutic effects,postoperative complications were analyzed.Results:The therapeutic effects were valuede at the time of discharge and during the follow up period according to different surgical manipulations. The valuation standardization was below:loss of symptoms,lessen of symptoms,no obvious change and aggravation of symptoms.The patients were defined as good cases if they had loss or lessen of symptoms.At the time of discharge,the result was good in 71 cases (71/80,88.7%), the good cases who underwent simple posterior fossa decompression,posterior fossa decompression plus cerebellar tonsil electrofulguration,posterior fossa decompression plus cerebellar tonsil partial resection were 8 (8/9,88.9%),13(13/15,86.7%)and 50 (50/56, 89.3%), the disparation among them was not statistically significant.At the time of follow up,the result was good in 61 cases (61/73,83.6%), the good cases of different surgical manipulations were 3 (3/8,37.5%) 12 (12/13,92.3%) and 46 (46/52,88.5%).The good rate of the patients who underwent simple posterior fossa decompression was statistically significant with the other two surgical manipulations,and the disparation between the other two surgical manipulations was not statistically significant. At the time of discharge,the complication rate were 11.1%,13.3% and 12.5%,the disparation among them was not statistically significant.At the time of follow up, syringomyelia decreased in 54 cases(54/63,85.7%) and accreted in 5 cases(5/63,7.94),there was no obvious change of syringomyelia in 4 cases(4/63,6.35%).Conclusion:Surgical managements were effective to the patients diagnosed as Chiari malformation,an appropriate manipulation shoule be chosed according to the conditon of the patient.At the time of discharge,the good rate of the patients who underwent posterior fossa decompression plus cerebellar tonsil electrofulguration or posterior fossa decompression plus cerebellar tonsil partial resection was similar with the patients underwent simple posterior fossa decompression,but it was much better at the time of follow up.The complication rate of the patients who underwent simple posterior fossa decompression was less than the other two surgical managements.The surgical manipulations we uesd were effective to syringomyelia associated with Chiari malformation.