Analysis Of The Treatment Of Arnold-chiari Malformation Type Ⅰ With Syringomyelia By Two Different Surgical Methods

Background:Chiari malformation is one of the common craniocervical junction deformities.It mainly manifests clinical symptoms of intracranial hypertension,medulla oblongata,and upper cervical spinal cord compression.There are four common types,of which Chiari type I is the most common,often with syringomyelia.Surgery is the main treatment for the disease,but there is still controversy regarding the choice of surgical method.Objective:This article aims to explore the clinical efficacy of Chiari type I malformation combined with syringomyelia through retrospective studies on the two methods of posterior fossa decompression and posterior fossa decompression combined with Cerebellar Tonsil-electrocautery.Methods:To collect the patients with Chiari type I malformation and syringomyelia diagnosed and operated by our hospital’s head and spinal cord MRI examination from 2010 to 2019,and use Karnofsky Functional Status score and Tator evaluation criteria to analyze.Basic information,preoperative symptoms,surgical methods,intraoperative conditions,postoperative complications,postoperative symptom recovery,and postoperative spinal syringomyelia improvement were compared for clinical efficacy of the two operations.Results:A total of 52 cases were included,including 19 males and 33 females;aged 18-62years(45.71 ± 9.34)years;22 cases of posterior fossa decompression combined with cerebellar tonsil electrocautery(group PFDCT),Postoperative symptoms improved in 20cases(20/22),2 cases had stable postoperative symptoms(2/22),and asymptomatic cases worsened;30 cases underwent posterior fossa decompression(group PFD),23 of which Postoperative symptoms improved(23/30),5 cases had stable postoperative symptoms(5/30),2 cases had worsening postoperative symptoms(2/30);complications occurred in 1cases of intracranial infection in group PFDCT,and 1 case of postoperative incision infection in group PFD;in the syringomyelia,19 patients in group PFDCT had reduced or disappeared syringomyelia,3 patients had no obvious change in syringomyelia,20 patients in group PFD had syringomyelia reduced or disappeared,and 7 patients had no syringomyelia Obvious changes,3 cases of spinal cord cavity increased than before surgery.Conclusion:Both posterior fossa decompression(PFD)and posterior fossa decompression combined with cerebellar tonsil electrocautery(PFDCT)have a definite effect on patients with CM-I and syringomyelia;Among them,the posterior cranial fossa decompression and combined cerebellar tonsil electrocautery(PFDCT)have better postoperative syringomyelia improvement rate and KPS score,with statistical difference(p <0.05).In summary,it can be considered that decompressive posterior cranial fossa decompression combined with cerebellar tonsil electrocautery(PFDCT)is more advantageous in improving the degree of improvement of spinal cavity and clinical symptoms.