后颅窝容积与Chiari Ⅰ畸形及其手术疗效的关系
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摘要
目的探讨ChiariⅠ畸形的发病机制及手术疗效。方法收集浙江大学附属邵逸夫医院2011年12月至2015年12月所收治的ChiariⅠ畸形患者符合且相关研究条件的20例为研究对象,对照组选自该院门诊或急诊因头痛等原因行头颅薄层CT检查的正常患者20例,采用回顾性研究,分析后颅窝容积与ChiariⅠ畸形发病机制之间的关系,以及后颅窝减压术的疗效。结果 ChiariⅠ畸形患者后颅窝容积小于正常对照组[(176. 2±11. 5) cm~3vs(184. 9±11. 4) cm~3,t=2. 403,P=0. 021]。将ChiariⅠ畸形患者按小脑扁桃体下疝程度分为Ⅰ度、Ⅱ度、Ⅲ度三组,后颅窝容积在Ⅰ度、Ⅱ度Ⅲ度三组患者中无明显统计学差异[(170. 1±9. 9) cm~3vs (184. 3±6. 4) cm~3vs(174. 8±12. 0) cm~3,F=2. 232,P=0. 138]。后颅窝减压术疗效分析中,症状消失组与症状改善组后颅窝容积有明显统计学差异[(170. 9±10. 4) cm~3vs (181. 7±9. 6) cm~3,t=2. 306,P=0. 034]。结论 ChiariⅠ畸形患者后颅窝狭窄,可能是导致小脑扁桃体下疝的原因之一,但与小脑扁桃体下疝的严重程度无明显关系。后颅窝减压术治疗后,后颅窝容积越小者,预示着手术疗效可能越好。
Objective To investigate the pathogenesis and surgery effect of Chiari malformation Type Ⅰ(CM-Ⅰ).Methods Twenty CM-Ⅰ patients meeting inclusion criteria treated in Sir Run Run Shaw Hospital between December2011 to December 2015 were retrospectively studied to explore the relationship between posterior cranial fossa volume(PFV) and CM-Ⅰ and the therapeutic effect of posterior fossa decompression. At the same time,20 normal outpatients undergoing thin-section computed tomographic(CT) scans for headache and other reasons were served as controls. Results The posterior fossa volume of CM-Ⅰ patients was smaller than that of normal group[(176. 2 ± 11. 5) cm~3 vs(184. 9 ±11. 4) cm~3,t = 2. 403,P = 0. 021]. CM-Ⅰ patients were divided into three groups according to the degree of cerebellar tonsil herniation: degree Ⅰ,Ⅱ and Ⅲ,and no differences in posterior fossa volume were found between patients of degreeⅠ,Ⅱ and Ⅲ. [(170. 1 ± 9. 9) cm~3 vs(184. 3 ± 6. 4) cm~3 vs(174. 8 ± 12. 0) cm~3,F = 2. 232,P = 0. 138]. There was a significant difference in therapeutic effect of posterior fossa decompression between symptom disappearance group and symptom improvement group[(170. 9 ± 10. 4) cm~3 vs(181. 7 ± 9. 6) cm~3,t = 2. 306,P = 0. 034]. Conclusion The posterior cranial fossa stenosis may be one of the causes of cerebellar tonsil herniation and is not obviously associated with its severity in CM-Ⅰ patients. When the posterior fossa decompression is performed for CM-Ⅰ patients,the smaller the posterior fossa volume is,the better the curative effect may be.
Objective To investigate the pathogenesis and surgery effect of Chiari malformation Type Ⅰ(CM-Ⅰ).Methods Twenty CM-Ⅰ patients meeting inclusion criteria treated in Sir Run Run Shaw Hospital between December2011 to December 2015 were retrospectively studied to explore the relationship between posterior cranial fossa volume(PFV) and CM-Ⅰ and the therapeutic effect of posterior fossa decompression. At the same time,20 normal outpatients undergoing thin-section computed tomographic(CT) scans for headache and other reasons were served as controls. Results The posterior fossa volume of CM-Ⅰ patients was smaller than that of normal group[(176. 2 ± 11. 5) cm~3 vs(184. 9 ±11. 4) cm~3,t = 2. 403,P = 0. 021]. CM-Ⅰ patients were divided into three groups according to the degree of cerebellar tonsil herniation: degree Ⅰ,Ⅱ and Ⅲ,and no differences in posterior fossa volume were found between patients of degreeⅠ,Ⅱ and Ⅲ. [(170. 1 ± 9. 9) cm~3 vs(184. 3 ± 6. 4) cm~3 vs(174. 8 ± 12. 0) cm~3,F = 2. 232,P = 0. 138]. There was a significant difference in therapeutic effect of posterior fossa decompression between symptom disappearance group and symptom improvement group[(170. 9 ± 10. 4) cm~3 vs(181. 7 ± 9. 6) cm~3,t = 2. 306,P = 0. 034]. Conclusion The posterior cranial fossa stenosis may be one of the causes of cerebellar tonsil herniation and is not obviously associated with its severity in CM-Ⅰ patients. When the posterior fossa decompression is performed for CM-Ⅰ patients,the smaller the posterior fossa volume is,the better the curative effect may be.
引文
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[9]Navarro R,Olavarria G,Seshadri R,et al. Surgical results of posterior fossa decompression for patients with ChiariⅠmalformation[J].Childs Nerv Syst,2004,20(5):349-356.
[10]Noudel R,Gomis P,Sotoares G,et al. Posterior fossa volume increase after surgery for Chiari malformation Type I:a quantitative assessment using magnetic resonance imaging and correlations with the treatment response[J]. J Neurosurg,2011,115(3):647-658.
[11]黄思庆,肖启华,李国平,等. Arnold-Chiari畸形合并脊髓空洞症的显微外科治疗310例临床分析[J].中华神经外科杂志,2005,21(2):40-43.
[12]Milhorat TH,Nishikawa M,Kula RW,et al. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management[J]. Acta Neurochirurgica,2010,152(7):1117.
[13]Welsch M,Antes S,Kiefer M,et al. Association of Chiari malformation and vitamin B12 deficit in a family[J]. Childs Nerv Syst,2013,29(7):1193-1198.
[2]Heiss JD,Patronas N,De Vroom HL,et al. Elucidating the pathophysiology of syringomyelia[J]. J Neurosurg,1999,91(4):553-562.
[3]Nishikawa M,Sakamoto H,Hakuba A,et al. Pathogenesis of Chiari malformation:a morphometric study of the posterior cranial fossa[J]. J Neurosurg,1997,86(1):40-47.
[4]Aydin S,Hanimoglu H,Tanriverdi T,et al. Chiari type I malformations in adults:a morphometric analysis of the posterior cranial fossa[J]. Surg Neurol,2005,64(3):237-241.
[5]Milhorat TH,Chou MW,Trinidad EM,et al. ChiariⅠmalformation redefined:clinical and radiographic findings for 364 symptomatic patients[J]. Neurosurgery,1999,44(5):1005-1017.
[6]Noudel R,Jovenin N,Eap C,et al. Incidence of basioccipital hypoplasia in Chiari malformation type I:comparative morphometric study of the posterior cranial fossa. Clinical article[J]. J Neurosurg,2009,111(5):1046-1052.
[7]Bindal AK,Dunsker SB,Tew JM Jr. ChiariⅠmalformation:classification and management[J]. Neurosurgery,1995,37(6):1069.
[8]Imakita S. Three dimensional CT angiography using helical scanning[J]. Clinical neurology,1995,35(12):1572-1574.
[9]Navarro R,Olavarria G,Seshadri R,et al. Surgical results of posterior fossa decompression for patients with ChiariⅠmalformation[J].Childs Nerv Syst,2004,20(5):349-356.
[10]Noudel R,Gomis P,Sotoares G,et al. Posterior fossa volume increase after surgery for Chiari malformation Type I:a quantitative assessment using magnetic resonance imaging and correlations with the treatment response[J]. J Neurosurg,2011,115(3):647-658.
[11]黄思庆,肖启华,李国平,等. Arnold-Chiari畸形合并脊髓空洞症的显微外科治疗310例临床分析[J].中华神经外科杂志,2005,21(2):40-43.
[12]Milhorat TH,Nishikawa M,Kula RW,et al. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management[J]. Acta Neurochirurgica,2010,152(7):1117.
[13]Welsch M,Antes S,Kiefer M,et al. Association of Chiari malformation and vitamin B12 deficit in a family[J]. Childs Nerv Syst,2013,29(7):1193-1198.