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Objective To summarize the clinical characteristics of adolescents with symptomatic Chiari malformation type Ⅰ,and evaluate the clinical results of small-range posterior fossa decompression on these patients.Methods Twelve adolescents with symptomatic Chiari malformation type Ⅰ,admitted to and underwent a standard small-range posterior decompression surgery in our hospital from December 2006 to December 2011,were chosen; their clinical data were retrospectively analyzed.The standard surgical technique was composed of limited bone cut in 2 cm×2 cm,weak current coagulation in shrinking the tonsils,probe of aqueduct cerebrospinal fluid outflow tract and Magendie's foramen of the fourth ventricle,and suture of the dural grafting with patch ofautologous fascia.Preoperative and postoperative symptoms and sizes of syringomyelia were compared.Results Short-term follow-up showed that the clinical symptoms of patients improved significantly,and MRI confirmed that the syringomyelia disappeared or shrank in all the patients and the shape of cisterna magna recovered.Eight patients accepted follow-up for more than six months,showing continues improvement of clinical symptoms.Conclusion Small-range posterior fossa decompression surgery is important means to alleviate adolescent symptomatic Chiari malformation type Ⅰ.
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Objective To dynamically analyze the evolutionary process of cerebral edema absorption and the level of local iron in rats with intra-cerebral hematoma by high-field strength 7 Tesla MRI and explore the characteristics and mechanism of secondary injury after intra-cerebral hematoma.Methods Sixteen adult SD rats (about 150 g) were randomly divided into experimental group (n=10) and control group (n=6).Rat models in the experimental group were established by performing injection of 50 μL their own venous blood into their right caudate nucleus accurately. Rats in the control group were used normal saline,instead.After that,head MRI (T2 and T2-star scans) was performed 1,2,3,7 and 14 d after the injection; their imaging features were compared. Results Nine rats in the experimental group survived and 1 died after the operation; in the early days (within 3 d), the T2 weighing imaging showed that the time of relaxation surrounding the hematoma was longer than that in control group,suggesting that the zone of the edema surrounding the hematoma became more clearly.In the early days (within 3 d),T2-weighted imaging was clear,and the time of relaxation surrounding the hematoma increased rapidly,steadily improved 3 d after the operation and reached its peak level 7 dafter the operation; the damage area absorption decreased steadily but turned widening 3 d later and reached the peak 7 d later.T2-star value reached the peak rapidly 3 d after the operation,and then,moderated the downturn.The rats in the control group showed no obvious signal changes under MRI,except those with needle tract injury. Conclusion Secondary injury after intra-cerebral hemorrhage shows a rapidly injury progress in the short terrn at first,and then,has intensify again after a stable period; the local iron diffusion trend is synchronized to the secondary injury,suggesting that iron may play a key role in the mechanism of secondary brain edema.
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Objective To analyze the temporospatial characteristics of traumatic brain injury (TBI) caused by Wenchuan earthquake, the distribution of the complex injuries, and the surgical timing and approaches. Methods The clinical data were retrospectively analyzed among 92 patients sustaining TBI in Wenchuan earthquake admitted in our department within 20 days after the injury. Results All the 92 patients came from the northwest Chengdu Champaign. Seventy-six patients were admitted within the initial 12 hours after earthquake, and 10 patients underwent surgical procedures. Forty-seven patients were cured, 31 were transferred to other provinces for further medical care, and 3 died. Conclusions Early TBI accounted for a large proportion of the TBI cases in Wenchuan earthquake, characterized by rapid progression of the condition. Early emergency surgeries can significantly improve the success rate of operations and lower the mortality rate.
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Objective To explore the effect of limited posterior fossa decompression(LPFD)in the treatment of Amold-chiari I malformation.Methods A retrospective analysis was conducted among 29 patients undergoing LPFD from 2004 to 2008.The standard surgical procedures included small osseous decompression of the occipital bone above the forarnen magnum,removal of the posterior arch of the atlas,separation of the arachnoid adhesions,and reduction of the inferior cerebellar tonsils,a dural graft for duraplasty.The outcomes of the surgeries were evaluated using the Tator criteria.Results Excellent results were obtained in 23(79.3%)patients according to the Tator scores,and good results were achieved in 6(20.7%)patients.During the follow-up of 15 patients,the syrmgomyelia was found to be further reduced in 9 patients,and 1 patient experienced recurrence.Conclusion Limited posterior fossa decompression is effective for management of Amold-chiari I malformation with minimal invasiveness and complications.