Microsurgical Treatment Of Chiari Malformation Combine With Syringomyelia Based On Cerebrospinal Fluid Dynamics

purposeThe microsurgical surgery for Chiari I malformation combine with syringom-yelia: Using cranial posterior fossa bone combined with membranous decompression.Partial atlantoaxial posterior arch.Acute separation of atlantooccipital fascia and resection.The outer layer of the epidural is stripped from the occipita l.The changes of imaging result,neurological function score,somatosensory evoked potential and other indicators were observed after follow-up.Comparative analysis was performed before surgery to evaluated The efficacy of the operation;Using phase contrast cine magnetic resonance image to selected the regions of interest at the cranial junction.Measured the peak velocity of the Cerebrospinal fluid in the corresponding area.The region of interest placed in the Subarachnoid space of the foramen magnum.at the same time,Determine the maximum anterior and posterior diameter of the syringomyelia.To discuss the changes of fluid dynamics in cerebrospinal fluid before and after operation.To discuss the effect of PCMRI on the indication and curative effect of Chiari malformation.Materials and methodsA total of 90 cases of Chiari I malformation treated by neurosurgery department of the second affiliated hospital of nanchang university were collected from March 2015 to May 2018.All the patients were treated with bone decompression of the posterior fossa of the posterior cranial fossa and the surgical treatment of the epidural and epidural detachment.Application of cerebral Magnetic Resonance Imaging,phase contrast cine magnetic resonance image and Chicago Chiari O utcome Scale respectively before and after surgery on the patients prognosis of syringomyelia before and after the largest diameter,foramen magnum cerebrospinal fluid velocity variation and neural function recovery were determined and do statistical analysis.Result1.The symptoms were significantly improved or disappeared 81 cases after the surgery(before the discharge),and there were no significant changes in 9 cases.No symptoms worsened or died.The average C hicago C hiari Outcome Scale score was 13.6(greater than 11 points indicating good clinical prognosis).The follow-up time for patients with spinal cord cavity recovery was from 3 months to 3 years,with an average of 11 months;A total of 58 patients were followed up,among which 51 patients were reduced or disappeared,6 were unchanged and 1 was enlarged.The follow-up time for patients with neurological recovery was from 2 months to 3 years,with an average of 14 months;A total of 68 patients were followed up,58 of them disappeared or improved,8 cases remained unchanged and 2 were aggravated.2.The head and tail peak velocity of occipital foramen magnum was significantly higher than that of the control group.After operation,the craniotomy and tail of the occipital foramen were significantly reduced.After operation,the main nerve function of C hiari malformation with abnormal fluid dynamics of cerebrospinal fluid was significantly improved.Conclusion1.Posterior fossa small bone window osseous decompression atlas pillow fascia release technique,the main purpose of the outer decollement of stiff backbone film on dismantling cranial neck obstruction transition area,recovery of cerebrospinal fluid circulation,can increase areas of cerebrospinal fluid flow,reduce peak velocity.This method is simple and effective,with few complications,and is an effective method to treat C hiari malformation.2.phase contrast cine magnetic resonance image is an effective tool for judging the curative effect of Chiari malformation.In clinical practice,we can choose the appropriate surgical patients according to the results of cerebrospinal fluid dynamics,and can predict the effect of the operation.