摘要
目的探讨家族性Chiari畸形的 临床及影像学特点。方法 回顾性分析 三个Chiari畸形家族共6例患者的临床及 影像学表现。其中4例患者行后颅窝减压 术,另外2例患者未手术。结果 第一个家 族为男性双胞胎患者,均患有Chiari畸形 1.5型(CM 1.5)及脊髓空洞,其中兄长合 并脊柱侧弯而无脑积水,弟弟合并脑积水 但无脊柱侧弯。第二个家族两位患者为母 子关系,均患有Chiari畸形I型(CM I)及 脊髓空洞,此外,母亲合并脊柱侧弯而无 脑积水,儿子合并脑积水但无脊柱侧弯。 第三个家族两位患者为非双胞胎姐妹关 系,其中姐姐为CM I合并脊髓空洞,而妹 妹为CM 1.5且无脊髓空洞,二者均无脊柱 侧弯及脑积水。4例患者行后颅窝减压术 后恢复良好。结论 家族性Chiari畸形可 发生于多种家族关系中,如双胞胎兄弟、 母子、非双胞胎姐妹等,且临床与影像学 表现可能差别很大。
Objective To analyze the clinical and imaging characteristics of familial Chiari malformations. Methods Clinical and imaging studies of 3 families with 6 Chiari malformation patients were retrospectively studied, 4 of which underwent posterior fossa decompression and the other 2 patients were not surgically treated. Results Patients of the first family were twin brothers, both with Chiari malformation type 1.5 (CM 1.5) and syrinx. The elder brother had scoliosis and the younger brother had hydrocephalus. Patients of the second family are mother and son, both with Chiari malformation type I (CMI) and syrinx. Besides, the mother had scoliosis and the son had hydrocephalus. Patients of the third family are non-twin sisters, and the elder sister had CM I and syrinx, but the younger sister had CM 1.5 without syrinx. The 4 patients who underwent posterior fossa decompression had good outcome. Conclusions Familial Chiari malformations may occur in many kinds of relationships, such as twins, mother and son, and non-twin sisters, and clinical and imaging manifestations maybe various.
【关键词】Chiari畸形;脊髓空洞;家族;后颅窝减压术;MRI
【中图分类号】R445.2;R744
【文献标识码】A
【DOI】10.3969/j.issn.1672-5131.2015.12.011
前言
小脑扁桃体下疝畸形,由奥地利病理学家Hans Chiari于1891年首 次报道[1],故也称Chiari畸形(Chiari malformation, CM)或ArnoldChiari畸形(Arnold-Chiari malformation, ACM)。其主要表现为小 脑扁桃体楔形延长、疝至枕大孔平面以下或可进入椎管中,从而引 起小脑、脑干、脊髓、后组颅神经及上段颈神经受损症状。目前,虽 然Chiari畸形病因及发病机理尚不明确,但一致认为其为一种先天性 疾病。Chiari畸形绝大多数为散发,但近年来国外已有多例家族性 Chiari畸形的报道,而国内相关报道很少[2,3]。在此,我们报道北京天 坛医院神经外科2012年1月~2013年12月收治的三个Chiari畸形家族, 旨在分析家族性Chiari畸形的临床表现与影像学特点。
中国CT和MRI杂志
第13卷, 第 12 期
2015年12月
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