Features On Radiological Imaging And Treatment Of Chiari Type â…  Malformation In Patients With Syringomyelia

Objective:The goal of this study was to determine the associationbetween the angle of brainstem spinal cord in patients with Chiari Ⅰmalformation and syringohydromyelia.Methods: This study analyzed32cases of Chiari Ⅰ malformation withsyringohydromyelia in our hospital from2002to2013,the32patients(16males and16females) ranging in age from8years from55years,mean,26.6yr,all of them were excluded from the diseases which cancause secondary ACM with SM,such as hydrocephalus or intracranialspace-occupying, the preoperative condition showed a progressive increase,each patient confirmed by a combined head cervical spine MRI. They areassociated with damage to the nervous system of different degree of symptomsand signs,clinical manifestation in medulla oblongata and spinal cordcompression, posterior cranial nerves and upper cervical nerve rootinvolvement, cerebellar dysfunction.The control group selected from theemergency or Outpatient due to Neck and shoulder trauma or head and neckpain with normal brain imaging on1.5-T MRI scanning, by MRI and detailedphysical examination to rule out the ACM and SM. Patients of Chiari Ⅰmalformation with syringohydromyelia were using normal brain imaging on1.5T Philips magnetic resonance imager (Gyroscan Intera; Philips MedicalSystems, Best, The Netherlands) sagittal MRI scanning, The control group arecompared with corresponding measurements obtained by using the sameMRI scanner (slice thickness=5mm), determine the midsagittal MRI image,marked the baseline on the relevant image that reflects the angle of brainstemspinal cord,the angles was performed on sagittal T1-weighted MRI scans andwas measured with a goniometer,.Record the age, gender, angle of brainstemspinal cord of both groups, and calculated the corresponding mean, standard deviation, and the distribution of frequencies. Analysis the differences of theangle of brainstem spinal cord between the patients in ACM-SM and patientsin the control group by Using statistical analysis software SPSS13.0, theindependent sample T test. Associated with the ACM-SM patients re-groupedby gender, analysis the relationship between the angle of brainstem spinalcord in ACM-SM patients and ender by using the application independentsamples T-test and one-way ANOVA, P <0.05with a significant difference.All patients in the ACM-SM group underwent surgery,5patients underwentsuboccipital decompression and syringomyelia drainage,3patients underwentodontoid resection and titanium plate fixed occipital–vertebrae cervicales,2patients underwent transoral odontoid resection and anterior cervicalfixation,22patients underwent suboccipital decompression.Results:The angle of brainstem-spinal cord in Chiari malformationwith syringomyelia patients is32.56°±6.032°, while the angle ofbrainstem-spinal cord in control group patients is24.56°±1.813°,andsignificantly greater than the control group patients (P <0.05),and significantlygreater than the control group patients with the gender,no significantdifferences were noted between the sexes among the patients in ACM-SMgroup (P<0.05).This implies the posterior fossa volume resulting somedegree of posterior tilt to the pons and medulla, because the clival angles werebelieved to be within normal limits,even resulting the angle of brainstem-spinal cord changes. Most authurs belive suboccipital decompression is thepreferred method of the ACM-SM complex disease,which can relieve thedirect causes of the SM,make the syringomyelia shrink and disappear,for thecanalis centralis’expansion is not obvious,we slso take this technique,whilethere are5patients, the canalis centralis’expansion is obvious,we used thesuboccipital decompression and syringomyelia drainage, due to the shortfollow-up time, the long-term efficacy remains to be seen.Some authursbelieve the atlanto-occipital joints is located in the craniocervical junctionarea,which supports the flexion and dorsiflexion and side rotation of thehead,so a simple suboccipital decompression without doing local fixed change the stability of the neck,it’s not only fail to relieve the patient’ssymptoms, but may aggravate the condition because of atlantoaxial dislocationcausing medulla oblongata, spinal cord compression increased, and there mayeven be serious complications such as quadriplegic,urinary incontinenceetc.The research results show that the Chiari malformation associated withsyringomyelia underwent odontoid resection the occipital cervical titaniumplate fixation can increase the stability of the neck,the dual role of bothdecompression and stability, can effectively improve the medullaoblongata,the degree of spinal cord compression,makes brainstem spinal cordangle will be corrected,which can effectively improve efficacy and preventrelapse.In this study,three patients underwent odontoid resection+titaniumplate fixed occipital–vertebrae cervicales,since classes lesions often leads tothe vertebrae cervicales lacking of stability,the posterior decompression makethe stability of a further decline, postoperative using cervical collarsupport,which makes the axis curvature get some degree of correction, theshort-term is effective. In this study, the ventral spinal cord of2patients wascompressed, patients with obvious damage to the pyramidal tractsymptoms,and we use transoral odontoid resection and anterior cervicalfixation,postoperative short-term symptoms were improved, due to the shortfollow-up time, long-term efficacy remains to be seen.Conclusion: The posterior fossa volume results some degree of posteriortilt to the pons and medulla,and the angle of brainstem-spinal cordchanges.Odontoid resection the occipital cervical titanium plate fixation caneffectively improve the compression of medulla oblongata andspinal cord,make the angle of brainstem spinal cord be corrected.