探讨不同手术方式治疗Chiari畸形Ⅰ型的临床疗效及并发症。

回顾性分析2010年1月至2018年10月晋城市人民医院神经外科收治的37例Chiari畸形Ⅰ型患者临床资料。选择性采用后颅窝小骨窗减压、改良硬脑膜成形、小脑扁桃体下疝切除等方法，解除神经压迫，恢复正常脑脊液循环。术后平均随访时间55.5个月，根据末次随访结果，按Tator标准评估疗效，分为优、良、差3个级别；MRI评估脊髓空洞变化情况。

全部病例均行后颅窝小骨窗减压、寰枕筋膜松解术。单纯小骨窗减压9例，小骨窗减压改良硬脑膜扩大成形术21例。行小骨窗减压改良硬脑膜扩大成形术并小脑扁桃体部分切除7例。按Tator标准，本组患者中19例为优（51.4%），12例为良（32.4%），6例为差（16.2%），有效率（优+良）83.8%。28例患者合并脊髓空洞症，其中18例空洞缩小，5例空洞消失，5例无明显变化。术后无感染病例，皮下积液者4例，脑脊液漏者1例。

扩大后颅窝容积，解除神经受压，重建枕骨大孔区脑脊液循环通路是治疗Chiari畸形Ⅰ型的基本原则。根据患者不同情况，选择性采用后颅窝小骨窗减压、改良硬脑膜成形、小脑扁桃体下疝切除等方法，疗效满意，并发症少。

To investigate the clinical efficacies and complications of different surgical methods for the treatment of Chiari typeⅠmalformation.

The clinical dates of 37 patients with Chiari typeⅠmalformation admitted to neurosurgery department of the People’s Hospital of Jincheng City from January 2010 to October 2018 were retrospectively analyzed. Small bone window posterior fossa decompression, modified duroplasty, resection of the cerebellar tonsillar herniation and other methods were selected to relieve nerve compression and restore normal cerebrospinal fluid circulation. The average following-up time was 55.5 months. According to the results of the last follow-up, the efficacy which was evaluated according to the Tator criteria, was divided into three grades: excellent, good, and poor. MRI was performed to assess changes in syringomyelia.

All cases have undergone the decompression of the posterior fossa small bone window and atlantooccipital fascia lysis. Nine cases have undergone simple small bone window decompression, 21 cases have undergone modified small bone window decompression and endocranium enlarged-duraplasty. Seven cases have undergone modified small-bone-window decompression, endocranium enlarged-duraplasty and partial resection of cerebellar tonsil. According to the Tator standard, the efficacy of 19 cases is excellent (51.4%), the efficacy of 12 cases is good (32.4%), of 6 cases are poor (16.2%). The effective rate of (excellent+good) is 83.8%. Among 28 cases with syringomylia, 18 cases had syringomyelia relief, 5 cases disappeared, and 5 cases showed no significant changes. There were no cases of infection after operation, 4 cases had suffered from subcutaneous effusion and 1case had suffered from cerebrospinal fluid leakage.

Expanding the volume of the posterior fossa, relieving the nerve compression, and reconstructing the cerebrospinal fluid circulation pathway in the foramen magnum region are the basic principles for the treatment of Chiari type Ⅰ malformation. According to the different conditions of patients, selective use of posterior fossa small bone window decompression, modified duroplasty, resection of the cerebellar tonsillar herniation and other methods had reached satisfactory clinical results with fewer complications.