Analysis Of Treatment Of Arnold-chiari Malformation Type Ⅰ By Posterior Fossa Decompression Without Duraplasty

Objective: To assess the efficacy of posterior fossa decompression without duraplastyfor Arnold-Chiari malformation type I.Methods: To collected28cases of Arnold-Chiari malformation type I at FujianMedical college attached Union Hospital from March2007to December2011. Allpatients were dignosed by MRI,of which25were with syringomyelia.Of these28patients,male19cases,female23cases,age ranged from12to56years old(mean40.3years old), the duration of disease from0.5to12years(mean3.4years).Allpatients were underwent posterior fossa decompression without duraplasty.Retrospective analysis curative effect after PFD without duraplasty.Results: The operation in all the28patients were performed successfully. This groupof patients underwent PFD without duraplasty have a short-term effective rate (92.9%)and a long-term effective rate (84.0%).There is no postoperative complications, suchas cerebrospinal fluid leak, intracranial infection, infection of incisional wound，except postoperative heart apnea. The efficacy of15cases with large bone windowdecompression is that86.7%short-term efficacy and71.4%long-term efficacy. Theefficacy of13cases with samll bone window decompression is that100.0%short-term efficacy and100.0%long-term efficacy.During follow-up,the position ofthe cerebellar tonsils: elevated in3cases (3/23,13.0%), unchanged in16cases (16/23,69.6%), descended in4cases (4/23,17.4%); the shape of Cisterna magna: Expanded in6cases (6/23,26.1%), unchanged in17patients (17/23,73.9%); the situation ofsyrinx size: narrowed in4cases (4/20,20.0%), unchanged in15cases(15/20,75.0%),expanded in1case (1/20,5.0%).Conclusions: PFD without duraplasty is effective to ACM-I patients, which has agreater short-term efficacy and less postoperative complications. No significant long-term efficacy may be related to preoperative neuropathological change and noobvious improvement of cerebrospinal fluid circulation path.The efficacy of usingsmall bone window decompression group may be better than using a large bonewindow decompression group.