| ObjectivesThe microsurgical surgery for Chiari malformation:decompression of the posteriorfossa was performed, the herniated tonsils were cut off, the artificial dura duraplasty wasused without tension Bone flap was expanded and put back. Post surgery, Follow-up thechange of Neural function, Syringomyelia, Imaging and electroneurophysiology in patientsto assess the results after operation; To examine intracranial and vertebral canal peakvelocities in related region Selects regions of interest above and below the craniocervicaljunction with PCMR.We discussed changes of the cerebrospinal fluid dynamics in Chiarimalformation pre/post operation, formation mechanism of Chiari malformation andsyringomelia by determination of the related index of Posterior fossa in midsagittal imagingand anterior cervical2-3(AC2-3), posterior cervical2-3(PC2-3), and aqueductcerebrospinal fluid flow hydrodynamics in axial imaging.Materials and methodsChapter2: A clinical study of microsurgical treatment of the posterior fossadecompression and reconstruction for Chiari malformation. Retrospective analysis80Chiari malformation of posterior fossa decompression and reconstruction fromDecember2009to June2013in the third military medical university first affiliated hospitalneurosurgery department.Chapter3: Analysis of cerebrospinal fluid flow hydrodynamics and morphology inChiari I malformation with cine phase-contrast magnetic resonance imaging. Retrospectiveanalysis52Chiari malformation of posterior fossa decompression and reconstructionfrom Juny2012to May2013and17healthy volunteers in the third military medicaluniversity first affiliated hospital neurosurgery department. Tentorial angle and clivus length in MRI T2weighted midsagittal imaging were examed in patients pre-surgery andcontrols. Anterior cervical2-3(AC2-3), posterior cervical2-3(PC2-3), and aqueductcerebrospinal fluid flow peak velocities in axial imaging were examined in patientspre-/post-surgery and controls by using PCMR..ResultsChapter2: The symptoms improved and disappeared in78and unchanged in2post-operation. No cases of symptom progression or death.73patients with syringomyelia.After surgery,66patients’ syringomyelia reduced,7patients’ syringomyelia keptunchanged.36patients with syringomyelia were followed up from1month to40months, mean1year. The syringomyelia reduced or disappeared in30,unchanged in4and expanded in2.The neurological function status of67patients were followed up from1month to3.5years,mean10months.The neurological function improved or recovered in57,unchanged in8and deteriorated in2.Chapter3:Patients have significantly shorter clivus length and larger tentorial anglethan do volunteers (P=0.004, P=0.019, respectively). The AC2-3cranial/caudal PV, PC2-3cranial/caudal PV and aqueduct cranial PV of patients pre-surgery were significantly lowerthan those of volunteers (P=0.034AC2-3cranial PV, P=0.000002AC2-3caudal PV;P=0.046PC2-3cranial PV, P=0.015PC2-3caudal PV; P=0.022aqueduct cranial PV) andincreased after operation (P=0.024AC2-3cranial PV, P=0.002AC2-3caudal PV; P=0.001PC2-3cranial PV, P=0.032PC2-3caudal PV; P=0.003aqueduct cranial PV). The aqueductcaudal PV of patients was higher than that of controls (P=0.004) and reduced post-operation(P=0.012). Patients with PC2-3cranial PV>2.63cm/s and aqueduct cranial PV>2.13cm/spre-operation, respectively, experienced symptom improvement post-operation.Conclusions1.The most important for Microsurgery of posterior fossa decompression andreconstruction of Chiari malformation is to remove the oppression of Craniocervicaljunction and Cerebrospinal fluid obstruction and reconstructing the cerebrospinal fluid flowdynamics.2.The innate bony dysontogenesis in patients contributes to tonsillar ectopia and exacerbates cerebrospinal fluid flow obstruction.3.There is a pressure gradient existedbetween SM and SAS which supports the perivascular space theory.4.Phase contrast cinemagnetic resonance image maybe a useful tool to predict patient prognosis post surgery. |
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