Different Surgery Treatments Of Chiari Malformation And Curative Effect Comparison

Objeetive:Clinically surgical treatment of Chiari malformation is numerous and controversial. Our study reviewed the different methods which treated the Chiari malformation (many of which associated with syringomyelia), and through the study We discuss therapeutic effect and complications of different surgical methods and the correlation problems.Methods:We review120Patients retrospectively confirmed as ACM by MRI from2003to2012year, including type Ⅰ43cases, type Ⅱ52cases, type Ⅲ25cases, given the clinical data, imaging data, surgical treatment, and follow-up results for review and analysis.There were63males and57females. The main purpose of operation is posterior fossa decompression. For type I:simple posterior fossa decompression and posterior fossa decompression and dural sac plasty cut. For Type Ⅱ and type Ⅲ.besides the two ways, posterior fossa decompression and dural sac incision plasty and syringomyelia bypass surgery additional. The methods of posterior fossa decompression were some different in different operations, for example, the area of bone decompression, the extent of removed cervical bone, resection of tonsils duraplasty and so onAccording to the type, choose different method of operation: Type Ⅰ43cases:①simple posterior fossa decompression20cases (not open dura mater sac)②posterior fossa decompression and dural sac incision plasty23cases (artificial dura mater attached14cases and epidural suture surgery9cases)type II52cases:①simple posterior fossa decompression10cases (not opened dura mater sac)②posterior fossa decompression and dural sac incision plasty31cases (artificial dura mater attached12cases and epidural suture surgery19cases)③posterior fossa decompression and incision plasty and dural sac and spinal cord is empty bypass surgery in11cases.(artificial dura mater attached5cases and epidural suture surgery6cases)Ⅲ type25cases:①simple posterior fossa decompression in5cases (not open hard membrane pouch)②posterior fossa decompression and dural sac incision plasty6cases (artificial dura mater attached3cases and epidural suture surgery3cases)③posterior fossa decompression and incision plasty and dural sac and spinal cord is empty bypass14cases.(artificial dura mater attached8cases and epidural suture surgery6cases)(1) compared in the same chiari malformation type according with chiari malformation group:different treatment effect after surgery (symptom, imaging data, the recurrence rate). within the same chiari malformation type (2) compared between different chiari malformation according to the group:the same operation method to treat different types of chiari malformation treatment effect after chiari malformation (symptom, imaging data, the recurrence rate).(3) surgery (1) group do not incise hard membrane capsule, surgery (2),(3) cut hard membrane pouch. Comparison of effect and complications after surgery of dural sac incision group and not cut group.(4) individual comparison:the two kinds of epidural keratoplasty (artificial dura mater attached with surgery and artificial dura mater epidural suture), compared of the intracranial infection incidence.Analysis of different surgical methods and therapeutic effect and complications of the relationship, and investigate the best surgical treatment of various types of Chiari malformation.ResuIts:When the patients of three types discharge:improvement in84cases (84.85%), stability in11cases (11.11%), deterioration in3cases (3.03%),1cases died (1.01%),1case died of postoperative infection. Follow-up of99cases (82.50%) and lost to follow-up rate was17.50%. follow-up for3months-10years. using SPSS17.0software package for analysis,:chiari malformation postoperative curative effect comparison between three types, the rank and inspection (P＞0.05), three groups of curative effect comparison there was no statistically significant difference.2, three different operation method, the postoperative complications, the rank and inspection (P＜0.05), the difference was statistically significant.3, two kinds of epidural keratoplasty (artificial dura mater attached with technique and epidural suture), intracranial infection incidence of contrast. By the chi-square test P＜0.05, with significant difference statistically significant.4, did not cut to epidural group compared with epidural group patients postoperative complications for the statistical analysis using chi-square test, P＜0.05, with significant difference statistically significant.comparison of the same type chiari malformation after different surgical treatment effect, using the chi-square test or Fisher’s exact probability method to get all group of the p values＞0.05, no difference between the statistics. There is no difference between different surgical methods curative effect with chiari malformation type.2, the same operation method to treat different types of treatment effect after chiari malformation, chi-square test or Fisher’s exact probability method is used to get all the p values＞0.05, no difference between the statistics. There is no difference between the same surgical method to treat different types of chiari malformation curative effect.3, two kinds of epidural keratoplasty (artificial dura mater attached with surgery and artificial dura mater-epidural suture), intracranial infection incidence of contrast, using the chi-square test or Fisher’s exact probability method for p=0.023, p＜0.05, statistically difference, namely In prevent intracranial infection, artificial dura mater-epidural suture operation is better than that of artificial dura mater attached with a surgery.4, compared between the group of did not cut to epidural and epidural group patients postoperative, the chi-square test or Fisher’s exact probability method is adopted to get p=5.58, p＞0.05, no difference between the statistics. Namely There is no difference between epidural group and not cut to epidural in patients group.Conclusion:Chiari malformation. also called Arnold Chiari malformation (ACM), is a kind of congenital dysplasia in the nervous system, dealing with Chiari malformation can use a variety of comprehensive operation method on the basis of the posterior fossa decompression,according to the circumstance, including simple decompression (osteoarthritis), posterior fossa decompression and dural sac incision plasty, pure syringomyelia bypass surgery, posterior fossa decompression and dural sac incision plasty and syringomyelia bypass surgery, and take into consideration of electric coagulation/resection of the cerebellar tonsils, peering into the center of the fourth ventricle hole, hole puncture, hollow shunt processing, etc. For different types ACM and different clinical manifestations of patients, choose appropriate surgical method can obtain satisfactory therapeutic effect. There is no difference between different surgical methods curative effect with chiari malformation type. There is no difference between the same surgical method to treat different types of chiari malformation curative effect. In prevent intracranial infection, artificial dura mater-epidural suture operation is better than that of artificial dura mater attached with a surgery. There is no difference between epidural group and not cut to epidural in patients group.