Efficacy Analysis Of Different Surgeries For Treatment Of Chiari Malformation

Objectives:Chiari malformation(Arnold-Chiari Malformation, ACM)is a kind of tonsillarherniation as the main feature of congenital diseases,the clinical manifestations of thedisease are nonspecific,and the clinical manifestations and severity of symptoms are ofteninconsistent,more performance for pillow neck pain, neck and shoulder pain,facialnumbness,blurred vision,corneal reflex retardation,hoarseness,pharyngeal reflex slow ordisappear,shrugging weakness (unilateral),Shenshe skew and so on.The exact cause ofChiari malformation mechanism is still unclear,as our understanding of the pathogenesisof Chiari malformation gradual deepening of understanding,to carry out a lot on theArnold-Chiari malformation with syringomyelia surgical treatment, but the effects aremore contentious.Chiari malformation individualized treatment has obvious differences,treatment options are no uniform standards.There is no way of literature through a surgicaltreatment can solve all the symptoms and dysfunction.This study is based on different conditions of patients with individualized surgery on96patients treated;explore improvements fossa decompression surgery with angioplasty cisterna magna treated with posterior fossa decompression surgery with dural repairsurgery to expand the clinical efficacy of the treatment of Chiari malformation and theoccurrence of complications.Methods:Neurology in our hospital in January2009to May2012was treated96cases ofsyringomyelia associated with Chiari malformation clinical data.All patients met Chiarimalformation with syringomyelia disease clinical diagnostic criteria.All patients wererandomly divided into two groups one(modified fossa decompression surgery cisternamagna forming joint surgery),50cases of group two(posterior fossa decompressionsurgery with expanded dural repair surgery)46cases.Two groups in age,gender,diseaseduration and other general information indicators,no significant difference,P>0.05,comparable equilibrium.Exclusion criteria:(1)exclude pregnant or lactating patients;(2)ruled out serious cardiovascular and cerebrovascular disease;(3)exclusion of patients withsevere mental disorders;(4)excluded patients with poor compliance;(5) excluded patientswith liver tumors.Group one,group two groups of patients after surgery were performed using cervicalcollar fixed in neurosurgical intensive care unit for treatment, while using analgesia pump,until the patient can breathe independently,it will pull out the endotracheal tube,into thegeneral ward treatment (bleeding, infection prevention and related nutrition therapy,etc.).All research data are used SPSS17.0statistical software package for statisticalanalysis,measurement data were expressed as mean±standard deviation(±s)representation,and using t-test;count data expressed as a percentage,χ2test was used for analysis.P<0.05was considered statistically significant.Results:1) in96patients,18cases symptoms completely improved,58cases improvedsymptoms,the symptoms did not change in16cases,symptoms worsen four cases,effective76cases,efficiency79.17%,postoperative subjective feeling ataxia, headache,muscle The recovery fastest,sensory disturbances slow recovery or obvious.A surgical group: cases completely improved in10cases, symptoms improved30 cases,the symptoms did not change in9cases,1case of worsening symptoms,effective40cases.The average length of stay7days,38patients tonsillar up or tip blunting.Group of two surgical procedures:cases completely improved in8cases,symptomsimproved in28cases,symptoms unchanged in7cases,symptoms worsen three cases,effective36cases.The average length of stay8days,39cases of herniation of thecerebellar tonsils disappear.Term efficacy between the two groups were roughly equal, the difference was notstatistically significant (P>0.05).2) All patients were followed up, no one was lost and deaths. During follow-up,96patients,the symptoms completely improved in14cases,symptoms improved in49cases,no change in symptoms in20cases,13cases of worsening symptoms,effective63cases,and total effective rate65.6%.Among them,13patients with symptoms worsen,the main manifestations ofneurological symptoms aggravated after recovery or remission, MRI showedsyringomyelia shrink or disappear after the hole to widen again. Early recovery of musclestrength is better than feeling restored, but not recovered to a certain extent, the degree ofsensory function restored to good, but the muscle atrophy poor recovery.A surgical group: cases symptoms completely improved in8cases,symptoms improved in26cases,no change in symptoms in11cases,symptoms worsen five cases,effective34cases.Group of two surgical procedures:cases,symptoms completely improved in6cases,symptoms improved in23cases,no change in symptoms in9cases,8cases of worseningsymptoms,effective in29cases.Long-term efficacy between the two groups were roughly equal, the difference was notstatistically significant (P>0.05).3)96cases to the hospital to outpatient follow-up review of MRI in patients withmultiple displays,syringomyelia whole group of four cases grow;shrink87cases,nochange in five cases. Increasing cases of syringomyelia cavity through OK-subarachnoidshunt surgery or physical therapy most patients symptoms eased. A surgical group:45cases of syringomyelia significantly reduced or disappeared,syringomyelia increased two cases, no change in three cases.Group of two surgical procedures:42cases of syringomyelia shrink or disappear,syringomyelia increased two cases, no change in two cases.Changes between the two groups is roughly equal syringomyelia, the difference was notstatistically significant (P>0.05).4) group,a technique where one case of wound infection, cerebrospinal fluid leakage in1case,1case of subcutaneous fluid,intracranial infection in one case; group of twosurgical procedures in two cases of wound infection, cerebrospinal fluid leakage0cases,subcutaneous fluid1cases of intracranial infection0cases, between the2groups isroughly equal to the incidence of (P>0.05). All cases were symptomatic after treatmentwas cured.Conclusion:1) in accordance with the patient’s actual thesis disease situation,surgical and clinicalimaging seen different were used fossa decompression surgery with angioplasty cisternamagna and posterior fossa decompression surgery with expanded while the group one,group two two surgical methods in terms of efficacy and complications indicators,nosignificant difference.2) fossa decompression surgery with angioplasty cisterna magna and posterior fossadecompression surgery with expanded dural repair surgery for chiari malformation withsyringomyelia have a better therapeutic effect.