The Curative Effect Analysis Of Reconstruction Of The Cisterna Magna In Patients With Chiari Malformation Type Ⅰ

Objective: The aim of this research was to evaluate the curative effects of various surgical procedures on patients with Chiari malformation type Ⅰ(CMⅠ)with or without syringomyelia,and explore the efficacy of reconstruction of the cisterna magna(including foramen magnum decompression,extensive duraplasty,arachnoidal adhesion lysis,and resection of the cerebellar tonsils).Methods: There were 37 patients with CMⅠ that received surgical treatment between March 2013 to December 2014 at affiliated hospital of Southwest Medical University.All patients were evaluated using magnetic resonance imaging(MRI),31 patients of a total were with syringomyelia.Of the patients,female 27 cases and male 10 cases,age from 11 to 67 years,mean 40 years,the duration of disease from 0.1 to 15 years,mean 3.8 years.All patients had different tonsil position,from 3 mm to 15 mm below the foramen magnum,mean 9.9 mm,and all cisterna magna disappeared.All patients were followed up in the 2 weeks,3 months and 1 year after operation,and analyzed curative effect after reconstruction of the cisterna magna.Results: The operation in all the 37 patients were performed though the same team.Postoperative MRI scans were available for all patients.Short-term follow-up of cerebellar tonsil has effective rate 100%,and the cisterna magna was reconstructed in 35 patients(94.6%),obvious reduction of syringomyelia in 6 patients(19.4%)and no significant change in 25 patients(80.6%).There was no mortality.But medium and long-term assessment of 4 patients tonsil position significantly down(but did not below the preoperative level);2 cases of patients with cisterna magna disappear again;obvious reduction of syringomyelia in 24 patients(77.4%)and no significant change in 5 patients(16.1%),worse in 2 patients(6.5%).Long-term assessment of symptoms were improved or eliminated in 35 patients(94.6%),2 patients(5.4%)had unchanged outcome.Pain improved in 20 patients(20/21,95.2%),paresthesias improved in 22 patients(22/25,88%),limb weakness improved in 10 patients(10/12,83.4%).Assess the efficacy of improved surgical treatment in the 2 weeks after operation according Chicago Chiari Outcome Scale(CCOS),5 patients below 11,mean 6.4,32 patients in 11~16,mean 11.8.While in 1-year after operation according CCOS,2 patients below 11,mean9.5,35 patients in 11~16,mean14.9.There had 1 cases developed rejection to artificial dural graft,and the regulation of immune therapeutic efficacy is not ideal.The second operation had performed to remove the artificial material and the patient recovered well.Five patients had a short-term lower fever,recovered after treatment.Result 1 case cerebrospinal fluid leak occurred after extensive duraplasty,and cured by continuous lumbar cistern drainage.No other special complications existed.Conclusion: The cisterna Magna is an effective methods for treatment of CMⅠ,including foramen magnum decompression,extensive duraplasty,arachnoidal adhesion lysis,and resection of the cerebellar tonsils.Long-term postoperative patients with clinical symptoms improved significantly,which has a greater long-term efficacy.Short-term follow up shows poor reduction of syringomyelia,while significantly long-term efficacy.The cisterna Magna has a significant recovery in the long-term prognosis and less postoperative complications.