Résumé
【Objective】 To investigate the clinical efficacy of modified posterior fossa decompression in treating Chiari type I malformation under the neuroendoscope. 【Methods】 We made a retrospective analysis of the clinical data of 63 patients with Chiari type I malformation treated at the Neurosurgery Department of The First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to December 2019. Of the patients, 28 ones underwent modified posterior fossa decompression assisted with neuroendoscopy (observation group) while 35 received posterior fossa decompression with duraplasty (control group). Tator grading, syringomyelia improvement and complications were compared between the two groups to evaluate the postoperative efficacy. 【Results】 The operations were successful in all the 63 patients and no death or severe neurological dysfunction was observed. The efficacy rate was 78.6% in the observation group and 54.3% in the control group, with significant difference (P0.05). 【Conclusion】 Modified posterior fossa decompression assisted with neuroendoscope is a safe and effective treatment for Chiari type Ⅰ malformation. Intraoperative dural watertight suture and dural-muscle suspension can help reduce the occurrence of subcutaneous effusion.
Résumé
Chiari malformation, also known as cerebellar tonsillar hernia, is a congenital developmental anomaly in which the cerebellar tonsils extend downward and protrude into the cervical spinal canal through the foramen magnum. It is a common craniocervical junction malformation. Its pathogenesis is complex and clinical manifestations are diverse. Also Chiari malformation is accompanied by many complications. Its pathogenesis remains not clear; therefore, its treatment is controversial. In recent years, new understanding and great progress have been made in the pathogenesis, diagnosis and treatment of Chiari malformation. In this paper, we discuss the classification, pathogenesis and diagnosis of Chiari malformation. In addition, we summarize the operation of Chiari with the hope to provide some help for further basic and clinical research.