Effect Of Two Operative Methods On Type Ⅰ Of Chiari Malformation With Syringomyelia

ObjectivesChiari malformation is a kind of congenital craniocervical junction area malformation,which is mainly divided into Ⅰ-Ⅳ type,in which type Ⅰ is the most common,with the cerebellar subtonsillar hernia to occipital subforaminal foramen 3-5mm herniation,and syringomyelia mostly accompanied by syringomyelia.At present,there are a variety of surgical methods,there is still no unified standard operation.This article summarized and compared the two surgical methods,and retrospectively analyzed the curative effect of the two surgical methods.The purpose of this study is to provide a reference for the selection of surgical methods in clinical treatment.MethodsThe clinical data of thirty cases of subtonsillar herniation with syringomyelia were retrospectively analyzed from June 2013 to June 2017 in the first affiliated Hospital of Kunming Medical University.Patients in group A were divided into two groups according to different operation methods.Group A was treated with simple posterior cranial fossa decompression,occipital bone window bite area was about 3 cm× 3 cm,atlas posterior arch bite was 2 cm,the atlantooccipital fascia was fully released,and the dura was not treated.A total of 14 patients in group B were treated with posterior cranial fossa decompression and membranous decompression.The bone window area was about 3cm X 3 cm,the posterior arch of atlas was bitten by 2 cm.The atlantooccipital fascia was loosened,and the occipital part of "Y" was cut to Cl,and then the dural membrane was sutured closely with biofilm.The changes of symptoms and signs in ten days and three months after operation were recorded by comparing and analyzing the curative effects of the two groups of patients in the following three aspects:the changes of symptoms and signs were recorded at ten days and three months after operation.The Tator score was used to evaluate the total effective rate of the two groups.After three months of operation,MRI was performed to compare the changes of tonsil and syringomyelia in the cerebellar tonsil and syringomyelia.The postoperative headache,fever,and subcutaneous effusion were recorded and compared between the two groups.Complications such as cerebrospinal fluid leakage and poor wound healing.Results(1)The total effective rate of group B was higher than that of group A ten days after operation,and the total effective rate of group B was higher than that of group A according to Tator score at three months.There was a significant difference in the total effective rate between the two groups(P<0.05).(2)In group A,three patients(21.43 out of fourteen patients)were retracted to the level above the foramen magnum of occipital bone.In group B,twelve of the sixteen patients in group B retracted from the cerebellar tonsil to the level above the foramen magnum of occipital bone,and twelve of the sixteen patients in group B retracted to the level above the foramen magnum of occipital bone.Group A had fourteen cases of syringomyelia becoming smaller or disappeared.The syringomyelia continued to increase in one case.In group B,the syringomyelia became smaller or disappeared in fifteen cases,and no syringomyelia continued to expand.There was significant difference in the recovery of syringomyelia between the two groups(P<0.05).(3)There were 4 cases of transient headache in group A and 6 cases of headache after operation in group A and B respectively.Postoperative fever was found in 4 cases and 3 cases respectively.One case of subcutaneous effusion was found in 0 cases.No cerebrospinal fluid leakage,poor wound healing and death in both groups.There was no significant difference in postoperative complications between the two groups.ConclusionsThe clinical improvement rate of the posterior cranial fossa decompression membrane decompression group is better than that of the simple posterior cranial fossa decompression group,which may be a better treatment method for some Chiari deformity type I patients with syringomyelia.