Chiari畸形Ⅰ型合并睡眠呼吸暂停综合征的手术治疗分析
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摘要
目的探讨手术干预Chiari畸形对Chiari畸形Ⅰ型合并有睡眠呼吸呼吸暂停综合征(CSAS)病人睡眠的影响。方法回顾性分析2012年7月至2016年5月收治的6例Chiari畸形Ⅰ型合并CSAS的临床资料,均行后正中入路软膜下下疝小脑扁桃体切除及枕大池重建术。术前、术后3个月行多导睡眠呼吸监测记录进入深睡眠至少4 h以上的呼吸暂停次数、每次暂停时间及每次暂停时的最低血氧饱和度。结果术后3个月,呼吸暂停次数明显减少,暂停持续时间下降,血氧饱和度上升,临床表现明显改善。术后复查MRI示下疝的扁桃体切除,延颈髓背侧压迫解除,脑脊液循环通畅,部分合并脊髓空洞较术前缩小,甚至有部分脊髓空洞完全消失。结论 Chiari畸形Ⅰ型合并睡眠呼吸暂停综合征,通过颈后正中入路软膜下下疝小脑扁桃体切除及枕大池重建术,能够明显改善病人睡眠呼吸暂停情况。
Objective To explore the effects of microsurgery on sleep in the patients with Chiari malformation type Ⅰ(CM-1) associated with central sleep apnea hypopnea sydrome(CSAS).Methods The cerebellar herniation tonsillectomy through subpial posterior and midline inferior approach and reconstruction of cisterna magna were performed in 6 patients with CM-1 associated with CSAS. The number of overnight apnea and minimum oxygen saturation at each pause time and every pause duration over 4 hours after deep sleep were determined with polysomnography before and 3 months after the operation in all the patients.Results Following-up 3 months after the operation showed that the symptoms, including the number of apnea, respiratory pause duration, oxygen saturation and so on, were relieved or disappeared in all the patients compared with before the operation(P<0.05). MRI 3 months after the operation showed that the herniated cerebellar tonsils were removed and the syringomyelia shrank or disappeared in all the patients.Conclusions The symptoms including sleep apnea and so on may be improved by the removal of herniated cerebellar tonsil with the surgery through supial posterior and midline approach and reconstruction of cisterna mana in the patients with CM-1 associated with CACS.
Objective To explore the effects of microsurgery on sleep in the patients with Chiari malformation type Ⅰ(CM-1) associated with central sleep apnea hypopnea sydrome(CSAS).Methods The cerebellar herniation tonsillectomy through subpial posterior and midline inferior approach and reconstruction of cisterna magna were performed in 6 patients with CM-1 associated with CSAS. The number of overnight apnea and minimum oxygen saturation at each pause time and every pause duration over 4 hours after deep sleep were determined with polysomnography before and 3 months after the operation in all the patients.Results Following-up 3 months after the operation showed that the symptoms, including the number of apnea, respiratory pause duration, oxygen saturation and so on, were relieved or disappeared in all the patients compared with before the operation(P<0.05). MRI 3 months after the operation showed that the herniated cerebellar tonsils were removed and the syringomyelia shrank or disappeared in all the patients.Conclusions The symptoms including sleep apnea and so on may be improved by the removal of herniated cerebellar tonsil with the surgery through supial posterior and midline approach and reconstruction of cisterna mana in the patients with CM-1 associated with CACS.
引文
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[14]刘龙,李力仙.Chiari畸形Ⅰ型发病机制研究进展[J].新乡医学院学报,2016,10(4):325-328.
[15]袁强,步星耀,余亚丽,等.Chiari畸形合并脑积水及睡眠呼吸暂停综合征1例并文献复习[J].中华脑科疾病与康复杂志:电子版,2015,5(1):62-64.
[16]de Oliveira Sousa U,de Oliveira MF,Heringer LC,et al.The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination:a systematic review and meta-analysis[J].Neurosurg Rev,2018,41(1):311-321.
[2]Urbizu A,Toma C,Poca MA,et al.Chiari malformation typeⅠ:a case-control association study of 58 developmental genes[J].PLo S One,2013,8(2):e57241.
[3]蔡吉章,杜小平,夏健,等.以中枢性睡眠呼吸暂停综合征为表现的Arnold-Chiari畸形合并脊髓空洞症1例[J].中华全科医师杂志,2013,12(8):672-673.
[4]Lee HS,Lee SH,Kim ES,et al.Surgical results of arachnoid-preserving posterior fossa decompression for ChiariⅠmalformation with associated syringomyelia[J].J Clin Neurosci,2012,19(4):557-600.
[5]Ma J,You C,Chen H,et al.Cerebellar tonsillectomy with suboccipital decompression and duraplasty by small incision for ChiariⅠmalformation(with syringomyelia):long term follow-up of 76 surgically treated cases[J].Turk Neurosurg,2012,22(3):274-279.
[6]尹一恒,余新光,周定标.先天性颅颈交界畸形胚胎学基础及治疗研究进展[J].中华外科杂志,2012,50(3):272-274.
[7]黄忻涛,王振宇.Chiari畸形外科治疗进展[J].中国临床神经外科杂志,2017,22(2):112-114.
[8]Dauvilliers Y,Stal V,Abril B,et al.Chiari malformation and sleep related breathing disorders[J].J Neurol Neurosurg Psychiatry,2007,78(12):1344-1348.
[9]Murray C,Seton C,Prelog K,et al.Arnold Chiari typeⅠmalformation presenting with sleep disordered breathing in well children[J].Arch Dis Child,2006,91(4):342-343.
[10]蔡吉章,杜小平,夏健,等.以中枢性睡眠呼吸暂停综合征为表现的Arnold-Chiari畸形合并脊髓空洞症1例[J].中华全科医师杂志,2013,8:672-673.
[11]阮玉姝,曾凡军.Chiari畸形合并混合型睡眠呼吸暂停综合征1例[J].实用医学杂志,2015,44(19):3287-3287.
[12]袁伟锋,徐虹,黄文杰.首诊睡眠呼吸暂停综合征的Chiari畸形1例[J].中国实用内科杂志,2009,29(7):667-668.
[13]Fernandez AA,Guerrero AI,Martinez MI,et al.Malformations of the craniocervical junction(Chiari typeⅠand syringomyelia:classification,diagnosis and treatment)[J].BMC Musculoskelet Disord,2009,10(1):107-111.
[14]刘龙,李力仙.Chiari畸形Ⅰ型发病机制研究进展[J].新乡医学院学报,2016,10(4):325-328.
[15]袁强,步星耀,余亚丽,等.Chiari畸形合并脑积水及睡眠呼吸暂停综合征1例并文献复习[J].中华脑科疾病与康复杂志:电子版,2015,5(1):62-64.
[16]de Oliveira Sousa U,de Oliveira MF,Heringer LC,et al.The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination:a systematic review and meta-analysis[J].Neurosurg Rev,2018,41(1):311-321.