Efficacy And Cerebrospinal Fluid Dynamics Of Modified Atlanto-occipital Decompression Combined With Cisternoplasty In Patients With Chiari Malformation Type Ⅰ With Syringomyelia

ObjectiveTo investigate the efficacy and cerebrospinal fluid dynamics of modified atlantooccipital decompression combined with cisternoplasty in patients with Chiari malformation type Ⅰ with syringomyelia.MethodsThis research take the retrospective study,in a January 2018-May 2021 in our hospital for treatment of patients with syringomyelia 50 cases as the research object,take posterior fossa decompression and duraplasty and tonsillar reduction operation patients as control group,and modified atlanto-occipital decompression combined with cisternoplasty operation patients as observation group.The treatment effect,Using phase contrast cine magnetic resonance image and Real-time Flow-sensitive Pencil Beam Imaging to selected the regions stroke volume(SV),mean flow rate(MF),reflux fraction(RF)and maximum peak flow rate(VD VU)of the two groups were compared.To evaluate the effect of modified atlanto-occipital decompression combined with cisternoplasty on the treatment of Chiari malformation type Ⅰ with syringomyelia.ResultsTherapeutic effectiveness: the effective rate was 92.0%,and the effective rate was64.0%,the difference was statistically significant(P<0.05).The CCOS score of the observation group(13.98 ± 2.59)was higher than that of the control group(12.17 ± 2.37),with statistical significance(P<0.05).Complications: The number of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Cerebrospinal fluid dynamics: After treatment,SV and MF in the midbrain aqueduct plane,ventral pontine plane and C3 ventral plane in the two groups increased,with a statistically significant difference(P<0.05).In the midbrain aqueduct plane and C3 ventral plane,VD and VU in the two groups decreased,with a statistically significant difference(P<0.05).VU in the ventral pontine plane of the observation group and the control group decreased,with a statistically significant difference(P<0.05).Analysis of influencing factors: The independent risk factors of cerebrospinal fluid dynamics were the length of syringomyelia and preoperative CCOS.ConclusionModified atlanto occipital decompression combined with cisternoplasty is effective for Chiari malformation type I with syringomyelia.It can improve the CCOS score,improve cerebrospinal fluid dynamics,and reduce complications.The independent risk factors of cerebrospinal fluid dynamics were the length of syringomyelia and preoperative CCOS.