中华神经外科疾病研究杂志

目的 比较软膜下小脑扁桃体切除术与后颅窝减压及硬脑膜扩大成形术治疗Chiari畸形Ⅰ型（CMI）的临床疗效。方法 回顾性分析2013年1月至2022年10月在北京大学第三医院延安分院（延安市中医医院）、延安大学附属医院及北京大学第三医院神经外科收治并行手术治疗的Chiari畸形Ⅰ型患者临床资料。共有64例患者被纳入本研究，根据手术方式分为软膜下小脑扁桃体切除组（A组=38例）和后颅窝减压及硬脑膜扩大成形术（B组=26例）。记录手术时间、术后并发症及预后等指标。结果 术前影像显示两组脊髓空洞发生率分别为81.58%(31/38)和84.62%(22/26)，差异无统计学意义（P=0.75）。最常见的临床表现为肢体麻木（A组73.68%VS B组65.38%），其次为肩颈及肢体疼痛（65.79%vs57.69%）和痛温觉障碍（47.37%vs 42.31%）。两组术后症状缓解率相似（73.68%vs 65.38%,P=0.58）。术后常见并发症均为中枢神经系统感染和脑脊液漏。A组平均手术时间为148.6 min，术中出血量约80 mL，住院时间平均10 d;B组分别为132 min、约52 mL和8 d。两组在手术时间方面差异有统计学意义（P=0.03）。结论 软膜下小脑扁桃体切除术与后颅窝减压及硬脑膜扩大成形术均能有效改善CMI患者的临床症状。但扁桃体切除组手术时间更长。因此，对于CMI的治疗，更推荐采用后颅窝减压及硬脑膜扩大成形术。

Objective To compare the clinical efficacy of cerebellar tonsillectomy and posterior cranial fossa decompression with expanded dura mater repair in the treatment of patients with Chiari malformation type Ⅰ(CMI). Methods A retrospective analysis was conducted on the clinical data of patients with Chiari malformation type Ⅰ who were admitted to the Neurosurgery Departments of Third Hospital of Peking University-Yan'an Branch(Yan'an Central Hospital), Affiliated Hospital of Yan'an University, and Third Hospital of Peking University and underwent surgical treatment from January 2013 to October 2022. A total of 64 patients were included in this study, who were divided into the cerebellar tonsillectomy group(Group A=38 cases) and the posterior cranial fossa decompression with expanded dura mater repair group(Group B=26 cases) based on the surgical methods. Among the 64 patients, 20(31.25%) were male and the age ranged from 34 to 62 years; 44(68.75%) were female and the age ranged from 42 to 69 years. The indicators such as operation time, intraoperative blood loss, postoperative complications, and prognosis were recorded. Results Preoperative imaging showed that the number of spinal syrinxes in both groups was 31(81.58%) and 22(84.62%) respectively, with no statistical difference between the two groups(P=0.75). The most common clinical manifestations were limb numbness(73.68% vs 65.38%), followed by shoulder-neck and limb pain(65.79% vs 57.69%) and pain and temperature sensation disorders(47.37% vs 42.31%). The postoperative relief rates of the two groups were similar(73.68% vs 65.38%), and the difference did not reach statistical significance(P=0.58). The common postoperative complications were central nervous system infection and cerebrospinal fluid leakage. The average operation time of Group A patients was 148.64 minutes, with about 80 ml of intraoperative blood loss and an average hospital stay of 10 days; the average operation time of Group B was 132 minutes, with about 52 ml of intraoperative blood loss and an average hospital stay of 8 days; there were statistically significant differences in operation time between the two groups(P=0.03). Conclusions Cerebellar tonsillectomy, simple posterior cranial fossa decompression and expanded dura mater repair can all improve the clinical symptoms of CMI. However, the cerebellar tonsillectomy group has more intraoperative time than the control group. Therefore, simple posterior cranial fossa decompression and expanded dura mater repair for the treatment of CMI is recommended.