本文選題：單純Chiari + Ⅰ型畸形　； 參考：《浙江大學(xué)》2017年博士論文

【摘要】：第一部分單純小腦扁桃體下疝畸形Ⅰ型(Chiari Ⅰ)的影像分析及診治策略背景和目的單純Chiari畸形的病理生理學(xué)基礎(chǔ)為因?yàn)榕咛ルA段中胚層體節(jié)枕骨部發(fā)育狀況不佳,造成枕骨未能發(fā)育完全、后顱窩窄小,但小腦發(fā)育不受影響,所以后顱窩空間狹小,造成扁桃體疝入至椎管中。目前臨床治療Chiar Ⅰ型畸形的主要手術(shù)方式有:(1)后顱窩骨性減壓術(shù);(2)后顱窩膜性減壓術(shù);(3)后顱窩減壓+脊髓空洞造瘺或分流術(shù);(4)后顱窩減壓+下疝小腦扁桃體切除+枕大池成形術(shù)。最近,有文獻(xiàn)報道Chiari畸形與寰樞椎不穩(wěn)定相關(guān),采用后路的復(fù)位、固定術(shù),獲得滿意的臨床治愈效果和隨訪結(jié)果。為此,我們評估了單純Chiari Ⅰ型畸形的后顱窩容積情況和寰樞椎穩(wěn)定性。方法回顧檢索我科在2010年8月至2016年10月期間,診斷為單純小腦扁桃體下疝畸形Ⅰ型(ChiariⅠ型)的臨床病例共65例。滿足納入標(biāo)準(zhǔn),結(jié)合排除標(biāo)準(zhǔn),共60例納入研究。取正常人60例作為對照組。病例組和對照組均進(jìn)行顱頸交界區(qū)的CT(Philip,256-slice)和 MRI(General Electric,3.0-tesla)掃描。所有研究對象的影像數(shù)據(jù)輸入PACS影像瀏覽系統(tǒng)(這一系統(tǒng)具有特殊的數(shù)字測繪功能)進(jìn)行測量,測量參數(shù)包括:小腦扁桃體下疝超過枕骨大孔的距離(E),延髓頸髓角(CMA),后顱窩腦容積(PFBV),后顱窩容積(PFCV),后顱窩容積相對比(RR=PFBV/PFCV),矢狀位關(guān)節(jié)面傾斜角(SJI),冠狀位關(guān)節(jié)面傾斜角(CJI),顱頸傾斜角(CT)。結(jié)果(1)小腦扁桃體下疝程度比較(E):兩組之間存在顯著性差異。(2)延髓頸髓角(CMA):兩組之間無顯著性差異。(3)后顱窩腦容積(PFBV):兩組之間無顯著性差異。(4)后顱窩容積(PFCV):兩組之間無顯著性差異。(5)后顱窩容積相對比(RR=PFBV/PFCV):兩組之間存在顯著性差異。(6)矢狀位關(guān)節(jié)面傾斜角(SJI):兩組之間無顯著性差異。(7)冠狀位關(guān)節(jié)面傾斜角(CJI):兩組之間無顯著性差異。(8)顱頸傾斜角(CT):兩組之間無顯著性差異。(9)在單純Chiari Ⅰ型畸形組,小腦扁桃體下疝程度(E)與后顱窩容積相對比(RR=PFBV/PFCV)之間進(jìn)行相關(guān)性分析,存在顯著正相關(guān)性。結(jié)論在單純ChiariⅠ型畸形中,枕骨輕度發(fā)育不良導(dǎo)致后顱窩相對狹小,后顱窩容積相對比(RR)增大,與小腦扁桃體下疝(E)嚴(yán)重程度顯著正相關(guān);寰樞椎穩(wěn)定性良好,未見不穩(wěn)定因素,與單純Chiari Ⅰ型畸形的發(fā)生發(fā)展無顯著相關(guān)性。臨床診治該類疾病應(yīng)以擴(kuò)大后顱窩容積和局部減壓為重點(diǎn)。第二部分顱底凹陷合并寰樞椎脫位(GroupA型BI)的影像分析及診治策略背景和目的顱底凹陷(BI)屬于一類臨床上廣泛存在的顱頸交界區(qū)(CVJ)畸形。Goel與Laheri[1]根據(jù)是不是合并寰樞椎脫位(AAD)把顱底凹陷分成A、B兩種類型。其病理生理學(xué)基礎(chǔ)是因?yàn)闄C(jī)體發(fā)育階段內(nèi)顱頸相接處各類不正常發(fā)育導(dǎo)致顱底扁平、內(nèi)翻,內(nèi)陷等,進(jìn)而對腦干、脊髓等神經(jīng)造成壓迫,最終形成各類神經(jīng)性的神經(jīng)脊髓綜合征。顱底凹陷合并寰樞椎脫位(BIand AAD,Group A型BI)是臨床診治的重點(diǎn)和難點(diǎn)。目前國內(nèi)外治療顱底凹陷合并寰樞椎脫位采取的主要術(shù)式包括經(jīng)后方入路的枕下減壓+枕頸融合內(nèi)固定術(shù),寰樞椎復(fù)位+融合內(nèi)固定術(shù),經(jīng)口腔齒狀突切除+復(fù)位固定術(shù),經(jīng)口腔寰樞椎脫位松解+復(fù)位固定術(shù),經(jīng)枕頸側(cè)方的遠(yuǎn)外側(cè)入路或枕下后外側(cè)入路齒狀突切除術(shù)等[2,3]。歸納起來,其手術(shù)方式以前路/后路的減壓+復(fù)位+固定和復(fù)位+固定為主。文獻(xiàn)報道的顱底凹陷合并寰樞椎脫位主要與寰樞椎不穩(wěn)定相關(guān),而后顱窩發(fā)育情況如何,是否存在后顱窩容積相對狹窄?為此,我們評估了顱底凹陷合并寰樞椎脫位的后顱窩容積情況和寰樞椎穩(wěn)定性。方法回顧檢索我科在2010年8月至2016年10月期間,診斷為顱底凹陷合并寰樞椎脫位(Group A型BI)的臨床病例共22例。滿足納入標(biāo)準(zhǔn),結(jié)合排除標(biāo)準(zhǔn),共20例納入研究。取正常人20例作為對照組。病例組和對照組均進(jìn)行顱頸交界區(qū)的CT(Philip,256-slice)和 MRI(General Electric,3.0-tesla)掃描。所有研究對象的影像數(shù)據(jù)輸入PACS影像瀏覽系統(tǒng)(這一系統(tǒng)具有特殊的數(shù)字測繪功能)。測量參數(shù)包括:Chamberlain's line(CL),寰齒間距(ADI),顱底角(CBA),斜坡長度(DB),Boogard角,延髓頸髓角(CMA),后顱窩腦容積(PFBV),后顱窩容積(PFCV),后顱窩容積相對比(RR=PFBV/PFCV),矢狀位關(guān)節(jié)面傾斜角(SJI),冠狀位關(guān)節(jié)面傾斜角(CJI),顱頸傾斜角(CT)。結(jié)果(1)Chamberlain's line(CL):兩組之間存在顯著性差異。(2)寰齒間距(ADI):兩組之間存在顯著性差異。(3)顱底角(CBA):兩組之間無顯著性差異。(4)斜坡長度(DB):兩組之間存在顯著性差異。(5)Boogard角:兩組之間存在顯著性差異。(6)延髓頸髓角(CMA):兩組之間存在顯著性差異。(7)后顱窩腦容積(PFBV):兩組之間無顯著性差異。(8)后顱窩容積(PFCV):兩組之間存在顯著性差異。(9)后顱窩容積相對比(RR=PFBV/PFCV):兩組之間存在顯著性差異。(10)矢狀位關(guān)節(jié)面傾斜角(SJI):兩組之間存在顯著性差異。(11)冠狀位關(guān)節(jié)面傾斜角(CJI):兩組之間無顯著性差異。(12)顱頸傾斜角(CT):兩組之間存在顯著性差異。(13)在顱底凹陷合并寰樞椎脫位組,Chamberlain'sline(CL)與CMA之間存在顯著負(fù)相關(guān)性;CL與RR之間存在顯著正相關(guān)性。(14)在顱底凹陷合并寰樞椎脫位組,Chamberlain's line(CL)與矢狀位關(guān)節(jié)面傾斜角(SJI)之間存在顯著正相關(guān)性;Chamberlain's line(CL)與顱頸傾斜角(CT)之間無顯著相關(guān)性。結(jié)論在顱底凹陷合并寰樞椎脫位中,枕骨重度發(fā)育不良導(dǎo)致后顱窩相對狹小,后顱窩容積相對比(RR)增大。寰樞椎發(fā)育不良導(dǎo)致寰樞椎側(cè)方關(guān)節(jié)面傾斜角增大,并脫位失穩(wěn),與齒狀突內(nèi)陷(CL)嚴(yán)重程度顯著正相關(guān)。臨床診治該類疾病應(yīng)以復(fù)位寰樞椎脫位,并固定穩(wěn)定寰樞椎為重點(diǎn),建議同期行后顱窩減壓擴(kuò)大容積。第三部分顱底凹陷合并扁平顱底(Group B型BI)的影像分析及診治策略背景和目的顱底凹陷(BI)屬于一類臨床上廣泛存在的顱頸交界區(qū)(CVJ)畸形。Goel與Laheri[1]根據(jù)是不是合并寰樞椎脫位(AAD)把顱底凹陷分成A、B兩種類型。其病理生理學(xué)基礎(chǔ)是因?yàn)闄C(jī)體發(fā)育階段內(nèi)顱頸相接處各類不正常發(fā)育導(dǎo)致顱底扁平、內(nèi)翻,內(nèi)陷等,進(jìn)而對腦干、脊髓等神經(jīng)造成壓迫,最終形成各類神經(jīng)性的神經(jīng)脊髓綜合征。顱底凹陷合并扁平顱底(BI and platybasia,GroupB型BI)在臨床研究及文獻(xiàn)報道中較少提及。因其寰樞椎無脫位,相對穩(wěn)定,所以目前國內(nèi)外治療顱底凹陷合并扁平顱底采取的主要術(shù)式包括經(jīng)后方入路的枕下減壓伴/不伴枕頸融合內(nèi)固定術(shù)[4]。而最近Goel的臨床研究認(rèn)為[5],該類患者仍然存在寰樞椎不穩(wěn)定,他僅予寰樞椎固定并重建穩(wěn)定性,而不行后顱窩減壓,同樣取得了良好的臨床療效。那么,在顱底凹陷合并扁平顱底病例中,是否存在后顱窩發(fā)育不良導(dǎo)致后顱窩容積相對狹窄?是否存在寰樞椎穩(wěn)定性問題?為此,我們評估了顱底凹陷合并扁平顱底的后顱窩容積情況和寰樞椎穩(wěn)定性情況。方法回顧檢索我科在2010年8月至2016年10月期間,診斷為顱底凹陷合并扁平顱底(Group B型BI)的臨床病例共10例。滿足納入標(biāo)準(zhǔn),結(jié)合排除標(biāo)準(zhǔn),共10例納入研究。取正常人10例作為對照組。病例組和對照組均進(jìn)行顱頸交界區(qū)的CT(Philip,256-slice)和 MRI(General Electric,3.0-tesla)掃描。所有研究對象的影像數(shù)據(jù)輸入PACS影像瀏覽系統(tǒng)(這一系統(tǒng)具有特殊的數(shù)字測繪功能)。測量參數(shù)包括:Chamberlain's line(CL),寰齒間距(ADI),顱底角(CBA),斜坡長度(DB),Boogard角,延髓頸髓角(CMA),后顱窩腦容積(PFBV),后顱窩容積(PFCV),后顱窩容積相對比(RR=PFBV/PFCV),矢狀位關(guān)節(jié)面傾斜角(SJI),冠狀位關(guān)節(jié)面傾斜角(CJI),顱頸傾斜角(CT)。結(jié)果(1)Chamberlain's line(CL):兩組之間存在顯著性差異。(2)寰齒間距(ADI):兩組之間無顯著性差異。(3)顱底角(CBA):兩組之間存在顯著性差異。(4)斜坡長度(DB):兩組之間存在顯著性差異。(5)Boogard角:兩組之間存在顯著性差異。(6)延髓頸髓角(CMA):兩組之間存在顯著性差異。(7)后顱窩腦容積(PFBV):兩組之間無顯著性差異。(8)后顱窩容積(PFCV):兩組之間存在顯著性差異。(9)后顱窩容積相對比(RR=PFBV/PFCV):兩組之間存在顯著性差異。(10)矢狀位關(guān)節(jié)面傾斜角(SJI):兩組之間無顯著性差異。(11)冠狀位關(guān)節(jié)面傾斜角(CJI):兩組之間無顯著性差異。(12)顱頸傾斜角(CT):兩組之間存在顯著性差異。(13)在顱底凹陷合并扁平顱底組,Chamberlain's line(CL)與延髓頸髓角(CMA)之間存在顯著負(fù)相關(guān)性。Chamberlain's line(CL)與后顱窩容積相對比(RR)之間存在顯著正相關(guān)性。(14)在顱底凹陷合并扁平顱底組,Chamberlain'sline(CL)與矢狀位關(guān)節(jié)面傾斜角(SJI)之間無顯著相關(guān)性。Chamberlain's line(CL)與顱頸傾斜角(CT)之間存在顯著正相關(guān)性。結(jié)論在顱底凹陷合并扁平顱底中,枕骨重度發(fā)育不良導(dǎo)致后顱窩相對狹小,后顱窩容積相對比(RR)增大。扁平顱底導(dǎo)致斜坡內(nèi)陷,顱頸傾斜角增大,與齒狀突內(nèi)陷(CL)嚴(yán)重程度顯著正相關(guān),未見明顯寰樞椎失穩(wěn)依據(jù)。臨床診治該類疾病應(yīng)以后顱窩減壓擴(kuò)大容積為重點(diǎn),前路減壓內(nèi)陷壓迫的斜坡齒狀突有待進(jìn)一步商榷。
[Abstract]:The first part is the imaging analysis of type I (Chiari I) of the simple cerebellar tonsillar hernia type I (Chiari I), the background and objective of the diagnosis and treatment strategy. The basis of pathophysiology of simple Chiari malformation is that the development of the occipital part of the mesoderm is not good, the occipital bone is not developed completely and the posterior fossa is narrow, but the development of the cerebellum is not affected. After that, the development of the cerebellum is not affected. The space of the cranial fossa is small and causes the tonsillar hernia into the spinal canal. The main surgical methods for the treatment of Chiar type I deformities are: (1) posterior fossa osseous decompression; (2) posterior fossa membrane decompression; (3) posterior fossa decompression plus spinal cavities or shunt; (4) posterior cranial fossa decompression plus cerebellar tonsillectomy plus occipital large cistern plasty. The report of Chiari malformation was associated with atlantoaxial instability, using posterior reduction and fixation to obtain satisfactory clinical curative effects and follow-up results. To this end, we assessed the volume of posterior fossa and atlantoaxial stability in simple Chiari type I malformation. Methods a retrospective retrieval of our department from August 2010 to October 2016 was diagnosed as simple. 65 cases of cerebellar tonsillar hernia malformation (type Chiari type I) were found in a total of 65 cases. A total of 60 cases were included in the study. 60 cases of normal people were taken as the control group. Both the case group and the control group were scanned by CT (Philip, 256-slice) and MRI (General Electric, 3.0-tesla) in the craniofacial junction. Like data input PACS imaging browsing system (this system has special digital mapping function), the measurement parameters include: the distance from the cerebellar tonsil hernia over the occipital foramen (E), the medulla cervical angle (CMA), the volume of the posterior cranial fossa (PFBV), the volume of the posterior fossa (PFCV), the volume contrast of the posterior fossa (RR=PFBV/PFCV), and the tilted sagittal joint. Angle (SJI), coronal articular surface inclination (CJI) and craniofacial angle (CT). Results (1) the degree of hernia in the cerebellar tonsillar (E): there was a significant difference between the two groups. (2) the medulla cervical spinal cord angle (CMA): there was no significant difference between the two groups. (3) the posterior cranial fossa (PFBV): there was no significant difference between the two groups. (4) the posterior fossa volume (PFCV): there was no significant difference between the two groups. (5) volume contrast between the posterior fossa (RR=PFBV/PFCV): there were significant differences between the two groups. (6) the sagittal articular surface inclination (SJI): there was no significant difference between the two groups. (7) the coronal articular surface inclination (CJI): there was no significant difference between the two groups. (8) the craniofacial inclination (CT): there was no significant difference between the two groups. (9) in simple Chiari I There was a significant positive correlation between the degree of E of the cerebellar tonsillar and the volume contrast of the posterior fossa (RR=PFBV/PFCV), and there was a significant positive correlation. Conclusion in the simple Chiari type I malformation, mild hypoplasia of the occipital fossa resulted in a relatively small posterior fossa, the contrast of the posterior fossa volume (RR), and the severe course of the cerebellar tonsil hernia (E). There is no significant correlation between the atlantoaxial stability and the development of the Chiari type I deformity. The clinical diagnosis and treatment of this kind of disease should be focused on the expansion of the volume of the posterior fossa and local decompression. Second parts of the skull base depression combined with the atlantoaxial dislocation (GroupA type BI) and the background of the diagnosis and treatment strategy And objective skull base depression (BI) belongs to a class of clinically extensive craniofacial junction (CVJ) malformation (CVJ) malformation.Goel and Laheri[1] based on not merging atlantoaxial dislocation (AAD) to divide the skull base into A, B two types. Its pathophysiology is based on the abnormal development of the cranial and cervical joints in the body during the development of the body and causes the flat and varus of the skull base. Internal depression and so on, and then the brain stem, spinal cord and other nerves causing oppression, and eventually forming all kinds of nerve spinal cord syndrome. The skull base depression combined with the atlantoaxial dislocation (BIand AAD, Group A BI) is the key and difficult point in the clinical diagnosis and treatment. The main surgical methods for the treatment of the skull base depression with the atlantoaxial dislocation include the pillow of the posterior approach Hypobaric + occipital cervical fusion internal fixation, atlantoaxial reduction plus fusion internal fixation, oral odontoid resection plus reduction fixation, oral atlantoaxial dislocation release and reduction fixation, distal lateral approach or occipital lateral odontoid resection through occipital cervical lateral approach, [2,3]., and the decompression of anterior / posterior approach + recovery Position + fixation and reduction + fixation. The literature reports that the skull base depression combined with atlantoaxial dislocation is mainly associated with atlantoaxial instability. How is the development of the posterior fossa and the relative stenosis of the posterior fossa? To this end, we evaluated the volume of posterior fossa and atlantoaxial stability in the skull base depression combined with atlantoaxial dislocation. From August 2010 to October 2016, 22 cases were diagnosed as the clinical cases of the skull base depression combined with the atlantoaxial dislocation (Group A type BI), which met the inclusion criteria, combined with the exclusion criteria, 20 cases were included in the study. 20 normal persons were taken as the control group. The case group and the control group were both CT (Philip, 256-slice) and MRI (Gen) in the craniofacial junction area. Eral Electric, 3.0-tesla) scan. The image data of all the subjects are entered into the PACS image browsing system (the system has a special digital mapping function). The measurement parameters include: Chamberlain's line (CL), atlantoodontoid space (ADI), the skull base angle (CBA), the slope length (DB), Boogard angle, the medulla cervix angle (CMA), the posterior cranial fossa, the posterior cranial fossa Volume (PFCV), posterior fossa volume contrast (RR=PFBV/PFCV), sagittal articular surface inclination (SJI), coronal articular surface tilt angle (CJI), craniofacial inclination (CT). Results (1) Chamberlain's line (CL): there were significant differences between the two groups. (2) there was a significant difference between the two groups. (3) the skull base angle (CBA): there was no significant difference between the two groups. (4) slope length (DB): there was significant difference between the two groups. (5) Boogard angle: there was a significant difference between the two groups. (6) the medulla cervical spinal cord angle (CMA): there was a significant difference between the two groups. (7) the posterior cranial fossa volume (PFBV): there was no significant difference between the two groups. (8) the volume of posterior fossa (PFCV): there was a significant difference between the two groups. (9) posterior cranium Volume contrast (RR=PFBV/PFCV): there were significant differences between the two groups. (10) sagittal articular surface inclination (SJI): there was a significant difference between the two groups. (11) the coronal articular surface inclination (CJI): there was no significant difference between the two groups. (12) the craniofacial inclination (CT): there was a significant difference between the two groups. (13) the skull base depression combined with the atlantoaxial. There was a significant negative correlation between Chamberlain'sline (CL) and CMA, and there was a significant positive correlation between CL and RR. (14) there was a significant positive correlation between the CL (CL) and the sagittal oblique angle (SJI) in the skull base depression combined with the atlantoaxial dislocation group, and there was no significant difference between Chamberlain's line (CL) and the craniofacial inclination angle. Conclusion in the skull base depression with atlantoaxial dislocation, the posterior fossa of the posterior cranial fossa is relatively small and the volume contrast of the posterior fossa (RR) increases. Atlas and axis dysplasia leads to an increase in the oblique angle of the lateral articular surface of the atlantoaxial joint, and the dislocation of the dislocation and the severity of the odontoid inversion (CL). The disease should be based on the reduction of atlantoaxial dislocation and the fixation of the atlantoaxial compression, and the posterior cranial fossa decompression is recommended for the same period. Third parts of the skull base depression combined with flat skull base (Group B BI) image analysis and diagnosis and treatment strategy background and objective skull base depression (BI) belong to a class of clinically widespread craniofacial junction (CVJ) malformed.Goel and Lahe Ri[1] is based on not merging the atlantoaxial dislocation (AAD) into the two types of the skull base depression, which is divided into A and B types. Its pathophysiology basis is that the abnormal development of the cranial and cervical joints during the development of the body causes the flat, inverted, and internal depression of the skull base, and then oppresses the nerves of the brain stem and the spinal cord and eventually forms a variety of neurogenic neurospinal synthesis. Combination of the skull base depression with the flat skull base (BI and platybasia, GroupB BI) is rarely mentioned in clinical and literature reports. Because of its atlantoaxial without dislocation and relatively stable, the main surgical procedures for the treatment of the skull base depression with flat skull base include the posterior decompression of the occipital decompression with / without occipital cervical fusion internal fixation. The clinical study of [4]. and the recent clinical study of Goel believed that the patients of this class still had atlantoaxial instability, he only given the atlantoaxial fixation and rebuilt stability, but not the posterior fossa decompression, which also achieved good clinical efficacy. Then, in the case of cranial depression with flat skull base, there was a posterior fossa volume in the posterior fossa volume. Relatively narrow? Is there a problem of atlantoaxial stability? To this end, we evaluated the volume of the posterior cranial fossa and the stability of the atlantoaxial spine in the skull base depression with the flat skull base. Methods a total of 10 clinical cases diagnosed as the skull base depression with the flat skull base (Group B type BI) were retrieved in our department from August 2010 to October 2016. CT (Philip, 256-slice) and MRI (General Electric, 3.0-tesla) scan in the craniofacial junction were scanned in the case group and the control group. The image data of all the subjects were entered into the PACS image browsing system (the system has special digital mapping). The measurement parameters include: Chamberlain's line (CL), ADI, CBA, DB, Boogard angle, cervical spinal cord angle (CMA), volume of posterior cranial fossa (PFBV), volume of posterior fossa (PFCV), volume contrast of posterior fossa (RR=PFBV/PFCV), sagittal oblique angle (SJI), oblique angle of coronal joint, craniofacial inclination angle (CT) results (1) Chamberlain's line (CL): there were significant differences between the two groups. (2) there was no significant difference between the two groups. (3) the skull base angle (CBA): there was a significant difference between the two groups. (4) the slope length (DB): (5) Boogard angle: there was a significant difference between the two groups. (6) the cervical medulla angle of the medulla (CMA) There was significant difference between the two groups. (7) the volume of the posterior cranial fossa (PFBV): there was no significant difference between the two groups. (8) the volume of posterior fossa (PFCV): there was a significant difference between the two groups. (9) the volume contrast between the posterior fossa (RR=PFBV/PFCV): there was a significant difference between the two groups. (10) the sagittal articular surface inclination (SJI): there was no significant difference between the two groups. 11) the oblique angle of the coronal joint (CJI): there was no significant difference between the two groups. (12) the craniofacial inclination (CT): there was a significant difference between the two groups. (13) there was a significant negative correlation between the Chamberlain's line (CL) and the medulla cervical medullary angle (CMA) between the skull base depression and the medullary cervical spinal cord (CMA), and there was a significant negative correlation between.Chamberlain's line (CL) and the volume of the posterior fossa (RR). There was a significant positive correlation between the Chamberlain'sline (CL) and the sagittal articular surface inclination (SJI) in the skull base depression with the flat skull base, and there was a significant positive correlation between the.Chamberlain's line (CL) and the craniocal inclination (CT). Conclusion in the skull base depression with the flat Skull base, the severe hypoplasia of the occipital bone led to the severe hypoplasia of the occipital bone. The posterior fossa is relatively small, and the volume contrast (RR) of the posterior fossa increases. The flat skull base leads to the incline subsidence, the craniofacial inclination increases, and the severity of the odontoid invagination (CL) is significantly positively correlated, and there is no evidence of the atlantoaxial instability. The clinical diagnosis and treatment of the disease should focus on the enlarged volume of decompression of the cranial fossa in the future, and the clivus teeth oppressed by anterior decompression of the decompression of the anterior fossa It needs further discussion.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R651.1

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