Clinical Observation Of Atlanto-occipital Decompression And Plastic Surgery For Chiari Malformation Type ? With Syringomyelia

Objectives:To investigate the effect and complications of optimized and improved atlanto-occipital decompression and plastic surgery,classic posterior cranial fossa decompression and cerebellar tonsillectomy for Chiari malformation with syringomyelia,and to provide basis for the choice of clinical surgical methods.Methods:The clinical data of 67 patients with Chiari malformation type ? and syringomyelia who underwent surgical treatment in our department from December2016 to December 2018 were retrospectively analyzed.According to the different surgical methods,31 patients who underwent atlanto-occipital decompression and plastic surgery were included in Group A.36 patients who underwent posterior fossa decompressionand cerebellar tonsil hernia resection were enrolled in group B.The short-term and long-term effects and complications were compared between the two groups.In this study,the atlanto-occipital decompression and plastic surgery was optimized and improved on the basis of classical posterior cranial fossa decompression,atlanto-occipital fascia decompression and dura splitting decompression.The main contents and steps were to remove 1/3 of the upper edge of the posterior arch of the atlas and the posterior edge of the foramen magnum,to repair and grind the occipital inner plate around the cerebellar tonsil,to incise and separate the atlanto-occipital fascia and the epidural layer around the foramen magnum and under the bilateral cerebellar hemisphere,to hang the periphery close to the bone margin,and to grind the thickened internal spine and plate by bone flaps plasty and reduction.Reconstruct the appropriate posterior fossa volume,and reconstruct the normal anatomy of the cranial fossa after plastic reduction.Results:The short-term curative effect of the two groups was compared and analyzed.According to the evaluation criteria proposed by Tator,the number of cases of improvement,stability and deterioration in group A was 26,5 and 0 respectively,with an effective rate of 83.87%.In group B,the number of cases of improvement,stability and deterioration was 22,13 and 1 respectively,with an effective rate of61.11%.The results of comparative analysis showed statistical difference(P < 0.05).(2)After 2 months to 2 years of follow-up,the long-term efficacy of the two groups was compared and analyzed: 28 cases improved,3 case stabilized and 0 case deteriorated in group A,the effective rate was 90.32%;31 cases improved,4 cases stabilized and 1 cases deteriorated in group B,the effective rate was 86.11%.There was no significant difference between the two groups(P > 0.05).(3)Postoperative complications occurred in 7 cases in group A and 17 cases in group B,The incidence of complications was 22.58% in group A and 47.22% in group B.The incidence of group A was lower than that of group B.The results of comparative analysis showed statistical difference(P < 0.05).Conclusion:Optimized and improved atlanto-occipital decompression and plastic surgery compared with the classic posterior fossa decompression and cerebellar tonsil hernia resection for Chiari ? malformation and syringomyelia has a significant short-term effect and a low incidence of complications,the long-term effect is similar.