儿童颅内幕上蛛网膜囊肿的手术治疗

目的总结儿童颅内幕上蛛网膜囊肿手术治疗的经验。方法回顾性分析56例幕上蛛网膜囊肿病儿的临床资料,均经手术治疗,手术方法包括囊肿壁部分切除加囊肿脑池交通术30例,囊肿壁部分切除并囊肿脑池交通加颞肌条填入术20例,囊肿-腹腔分流术5例及神经内镜下囊肿壁部分切除并造瘘术1例。结果病儿术后临床症状均不同程度改善,颅内压增高症状术后均消失。术后高热(39℃)12例,并发颅内血肿4例,无手术死亡。随访3个月～5年,囊肿消失18例,缩小80%以上22例,缩小50%～80%8例,无明显变化6例;2例合并脑积水者,1例脑室较术前略缩小,另1例无变化。结论外科手术是儿童颅内幕上蛛网膜囊肿的有效治疗方法,术中仔细和轻柔操作是预防和减少相关手术并发症的关键。     

颅内蛛网膜囊肿治疗中的有关问题

目的 探讨颅内蛛网膜囊肿的手术指征和手术方法.方法 回顾性分析209例颅内蛛网膜囊肿患者的临床表现、影像学资料、治疗方法等临床资料.结果 其中198例行CT蛛网膜下腔-脑池造影,非交通性47例均行于术治疗.43例行囊肿大部切除+脑池开放术,3例行脑室-腹腔分流术,1例行囊肿-腹腔分流术.所有手术病人手术顺利,各种术式各有利弊.结论 颅内蛛网膜囊肿应根据囊肿大小、临床症状体征、与蛛网膜下腔是否交通及年龄来决定治疗方式.手术首选囊肿切除+脑池开放术.     

儿童蛛网膜囊肿伴癫的外科治疗(附13例报告)

目的探讨儿童颅内蛛网膜囊肿(arachnoidcyst,AC)与癫的关系以及外科治疗方法.方法手术治疗颅内蛛网膜囊肿伴癫的儿童13例,其中额叶2例,顶叶l例,颞叶8例,枕叶2例,囊肿直径在3cm以下3例,3～6cm9例,6cm以上1例,均采用颅内蛛网膜囊肿加致灶切除.结果13例病人中,完全不发作有4例,显著改善有7例,无变化2例.结论儿童颅内蛛网膜囊肿伴癫具有脑皮质结构性异常,采用颅内蛛网膜囊肿加致灶切除效果较为理想.     

颅内蛛网膜囊肿57例治疗分析

目的探讨网膜囊肿(IAC)的治疗方法及疗效。方法回顾性分析我院2009-2013年收治的57例颅内蛛网膜囊肿患者的临床资料,其中手术切除囊肿壁同时打通颅底蛛网膜池26例,囊肿-腹腔分流术18例,神经内镜造瘘11例,保守治疗2例。对患者术后症状体征改善、影像学囊肿体积及术后并发症等进行分析。结果 57例患者神经系统症状和体征均不同程度的改善。影像学随访结果表明开颅手术切除并脑池开放术,囊肿体积明显缩小,脑组织膨隆较理想。结论手术切除囊肿壁同时打通颅底蛛网膜池近期效果明显,适于基层医院开展。     

颅内蛛网膜囊肿的手术治疗

目的探讨颅内蛛网膜囊肿的手术指征和手术方法。方法回顾性分析手术治疗的26例颅内蛛网膜囊肿患者的临床资料。开颅手术治疗18例,行囊肿大部分切除并脑池开放术,其中囊肿部分切除并囊肿-脑室沟通术1例,1例因合并慢性硬膜下血肿而同时行血肿壁切除术。囊肿-腹腔分流术8例,其中因合并脑积水而行脑室-腹腔分流术2例。结果所有患者术后随访0．5～6年,所有患者症状均得到改善。头颅CT或MR2复查示囊肿消失10例,显著缩小15例,无变化1例。术后未出现严重并发症。结论囊肿切除并脑池开放术和囊肿-腹腔分流术治疗颅内蛛网膜囊肿对改善患者症状均有良好效果,但各有优势和适应症。     

颅内蛛网膜囊肿临床治疗分析

目的探讨颅内蛛网膜囊肿(IAC)的临床特征和治疗方法。方法IAC患者53例,其中47例行手术治疗,术式包括微创囊肿切除加局部的蛛网膜下腔及相关脑池开放术、蛛网膜囊肿部分切除术及囊肿-腹腔分流术等;6例未手术者临床随访观察。结果大部手术治疗者获得良好疗效,癫痫能得到控制或发作次数减少。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿部分切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。     

手术治疗颅内蛛网膜囊肿34例

目的 探讨颅内蛛网膜囊肿手术治疗的效果.方法 回顾分析手术治疗的34例颅内蛛网膜囊肿患者的临床资料,手术方式包括开颅囊肿切除并脑池开放术、囊肿-腹腔分流术以及神经内镜造瘘术.结果 34例术后随访2个月~5年,平均2年,复查颅脑CT示:囊肿消失11例,囊肿明显缩小12例,略有减小6例,无变化5例.结论 对有临床症状的颅内蛛网膜囊肿应积极手术治疗;充分沟通临近脑池及蛛网膜下腔及确切止血是手术成功的关键.     

颅内蛛网膜囊肿的临床诊治（附22例报告）

目的探讨颅内蛛网膜囊肿的临床诊治。方法回顾分析手术治疗22例颅内蛛网膜囊肿患者临床资料,术式包括蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术及囊肿-腹腔分流术等。结果17例获得良好疗效,6例癫痫患者5例症状消失。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。     

儿童颞部蛛网膜囊肿的手术治疗

目的探讨儿童颞部蛛网膜囊肿的手术方法。方法回顾性分析手术治疗儿童颞部蛛网膜囊肿68例患者的临床资料,56例行显微镜下囊壁切除+脑池交通术,7例行囊肿-腹腔分流术,5例行内镜下囊壁切除+脑池交通术。结果术后随访6个月到3年,28例影像学复查显示:13例囊肿完全消失,46例囊肿体积较术前有不同程度缩小,无明显变化的有9例。结论显微镜下囊壁切除+脑池交通术对儿童颅内蛛网膜囊肿有着良好的治疗效果,可以作为首选的手术方式。     

19例颅内蛛网膜囊肿手术治疗体会

目的对蛛网膜囊肿患者手术效果及术后并发症相关因素进行分析。方法选取我院2010-07-2015-01收治的蛛网膜囊肿病人19例为研究对象,分析治疗效果及术后并发症。结果行蛛网膜囊肿壁切除+脑池造瘘术15例,行囊肿-腹腔分流术4例,手术均取得良好治疗效果。术后发热3例,CSF细胞数增高,给予抗生素及腰穿治疗后好转;1例儿童患者术后出现脑膜-肌肉膨出,经腰穿治疗及局部穿刺放液,出院1a后复位;无死亡病例。结论蛛网膜囊肿切除+脑池造瘘及囊肿-腹腔分流术均能取得良好疗效,需根据具体病例选择手术方式;无菌操作、严密缝合硬膜、适当选择抗菌药物、儿童局部骨瓣复位等措施能有效减少术后并发症的发生。     

听神经瘤切除术中内听道内肿瘤的个体化处理

目的 探讨听神经瘤的内听道部分的处理方法及其效果。方法 回顾性分析2015年1月至2017年12月采用枕下乙状窦后入路手术切除的37例听神经瘤的临床资料。依照内听道病理形态及病人综合情况，19例采取磨除部分内听道后壁法，16例采用刮除法，2例内听道内肿瘤未予处理。结果 全部病例面神经均解剖保留，术后1周面神经功能I~Ⅱ级34例，Ⅲ~Ⅳ级2例，Ⅴ级1例；术后3个月面神经功能Ⅰ~Ⅱ级35例（94.6%），Ⅲ级1例（2.7%），Ⅳ级1例（2.7%）。肿瘤全切除33例，次全切除4例。术后发生瘤腔再出血1例，脑脊液耳漏合并颅内感染1例。无死亡病例。术后随访1~3年，1例残余肿瘤明显增大，行伽玛刀治疗后得到控制；其余病例未见明显残余肿瘤增大或复发。结论 枕下乙状窦后入路手术切除听神经瘤中，依照内听道病理形态及病人综合情况，个体化处理内听道内肿瘤安全有效。     

Clinical and Neuroimaging Outcomes of Surgically Treated Intracranial Cysts in 110 Children

Objective

The indications and optimal surgical treatments for intracranial cysts are controversial. In the present study, we describe long-term clinical and neuroimaging results of surgically treated intracranial cysts in children. The goal of this study is to contribute to the discussion of the debate.

Methods

This study included 110 pediatric patients that underwent surgeries to treat intracranial cysts. Endoscopic cyst fenestrations were performed in 71 cases, while craniotomies and cyst excisions (with or without fenestrations) were performed in 30 patients. Cystoperitoneal shunts were necessary for nine patients. Long-term results were retrospectively assessed with medical and neuroimaging records.

Results

Clinical and radiological improvement was reported in 87.3% and 92.8% of cases, respectively, after endoscopic neurosurgery, and in 93.3% and 100% using open microsurgery whereas 88.9% and 85.7% after shunt operation. There were no statistical differences in clinical outcomes (p=0.710) or volume reductions (p=0.177) among the different surgeries. There were no mortalities or permanent morbidities, but complications such as shunt malfunctions, infections, and subdural hematomas were observed in 56% of the patients that had shunt operations. A total of 13 patients (11.8%) underwent additional surgeries due to recurrences or treatment failures. The type of surgery performed did not influence the recurrence rate (p=0.662) or the failure rate (p=0.247).

Conclusion

Endoscopic neurosurgeries are less invasive than microsurgeries and are at least as effective as open surgeries. Thus, given the advantages and complications of these surgical techniques, we suggest that endoscopic fenestration should be the first treatment attempted in children with intracranial cysts.     

颅内蛛网膜囊肿的治疗策略(附55例报告)

目的探讨颅内蛛网膜囊肿的治疗方法及临床疗效。方法回顾性分析2001年8月至2006年6月经头颅MRI和/或CT确诊的55例颅内蛛网膜囊肿患者的临床资料,其中29例经保守治疗症状缓解,18例显微镜下行囊肿壁切除术,并与脑池、蛛网膜下腔沟通,8例行囊肿分流术。结果随访3月~5年(平均15月)所有患者经治疗后症状均有所改善,复查颅脑CT或MRI显示,行开颅手术的18例患者中,15例患者囊肿体积缩小或消失;行分流手术的8例患者中,5例患者囊肿体积缩小或消失。结论难治性癫痫、高颅内压和出现脑组织受压的体征仍是手术治疗蛛网膜囊肿的可靠指征。锁孔入路囊壁开窗并充分建立囊腔与脑池之间的交通仍是治疗蛛网膜囊肿首选方法。     

儿童颅内外沟通巨大皮样囊肿合并颅内感染的诊治分析

目的 探讨儿童颅后窝中线部位颅内外沟通巨大皮样囊肿继发颅内感染的诊治方法及治疗效果。方法 回顾性分析2016~2020年收治8例颅后窝中线部位、颅内外沟通巨大皮样囊肿继发颅内感染的临床资料。结果 8例均有头皮窦道、经颅骨及硬脑膜缺损使颅内外皮样囊肿相沟通，并继发颅内感染。首选敏感抗菌素控制感染达标后，开颅手术治疗，囊肿完整切除7例，顺利治愈，术后3周内出院；1例因囊壁炎症性浸润，分离时囊壁破裂，内容物外溢，全切囊肿后，反复温生理盐水冲洗，术后发生无菌性脑膜炎、延迟2个月治愈出院。全部患儿至少随访3个月，未见复发。结论 儿童颅后窝中线部位颅内沟通的皮样囊肿易反复继发颅内感染，应尽早诊断，首选敏感抗菌素控制感染后手术完整切除颅内外沟通的皮样囊肿，可取得良好效果     

神经内镜治疗颅内蛛网膜囊肿108例临床分析

目的 探讨神经内镜治疗颅内蛛网膜囊肿的效果,为蛛网膜囊肿的治疗提供参考.方法 回顾性分析1998年5月至2010年5月使用神经内镜治疗的108例颅内蛛网膜囊肿患者的临床资料,总结并分析手术适应证的把握及手术效果.结果 108例均成功行造瘘术.短期内症状好转68例(63%,68/108),其中头痛、恶心及呕吐症状缓解40例(95%,40/42);年龄小于12岁74例中症状好转48例(65%,48/74),其余34例中症状好转20例(59%,20/34).术后1周影像学结果示术前合并脑积水16例均明显缓解.手术并发症包括发热、硬膜下积液、皮下积液、动眼神经麻痹、颅内感染,除1例死于术后颅内感染外,其余经处理后治愈出院.94例随访3月,影像学检查示蛛网膜囊肿消失或缩小61例(64.9%,61/94),无变化33例(35.1%,33/94);临床症状较术前改善54例(57.4%,54/94),其中癫痫好转8例(44.4%,8/18);86例术后随访半年,影像学检查示蛛网膜囊肿造瘘术无效46例(53.5%,46/86).结论 神经内镜治疗颅内蛛网膜囊肿长期有效率不高,需严格把握手术适应证.     

内窥镜技术在神经外科手术中的应用研究

目的探讨内窥镜技术在神经外科手术治疗中的价值。方法采用神经内窥镜进行内镜下和内镜控制下以及内镜辅助下的各种神经外科手术122例,包括各种颅内肿瘤切除68例,颅内血肿清除51例,颅内囊肿切除2例,脑积水造瘘1例。结果30例高血压性脑出血患者血肿清除满意,21例慢性硬膜下血肿术后无复发;48例肿瘤全切除,15例次全切除,5例大部切除;1例囊肿全切除,另1例囊肿缩小;1例脑积水患者术后症状明显改善,脑室明显缩小。结论内窥镜技术在微侵袭神经外科手术中具有广泛的临床应用前景。     

Microsurgical management of cerebral parenchymal cysticercosis

Objective

Microsurgery is an optional way to treat parenchymal neurocysticercosis. The aim of this study is to evaluate the therapeutic efficacy of microsurgery in cerebral parenchymal cysticercosis.

Materials and methods

A retrospective analysis was performed of the clinical data and outcomes of microsurgery in 20 cases of cerebral parenchymal cysticercosis.

Results

All head segments found in cysticercus cysts were removed completely. Total resection of the cystic wall was achieved in 16 cases and subtotal resection in 4 cases. Twelve patients recovered from intracranial hypertension soon after the operation. No novel complications or deaths occurred postoperatively. The patients were followed up for 3 months to 10 years; among them, 14 patients who had epilepsy before surgery were markedly improved and controlled, 4 of 5 patients recovered from hemiparesis within 6 months after surgery, and 2 patients with cerebellar ataxia showed improvement. Two patients were lost to follow-up.

Conclusions

Despite a high rate of misdiagnosis of cerebral parenchymal cysticercosis, microsurgery is associated with satisfactory clinical outcomes in appropriately selected patients.     

Cerebral hydatid cysts in children

Twelve children with intracranial cysts ofEchinococcus granulosus underwent surgery during a period of 5 years and constituted 19% of all children operated on for intracranial space-occupying lesions. The more common symptoms were raised intracranial pressure (8 cases) and hemiparesis (7 cases). The total number of procedures was 14, with a standard craniotomy approach in 13. In 6 the cysts were removed without puncture or rupture, in 5 puncture and drainage were carried out before removal of capsule, and in 3 the cyst ruptured accidentally. Recurrence of multiple cysts occurred in 1 case and another patient was reoperated on twice for recurrent cysts after an operation in another center. There was no mortality. Non-bacterial meningitis occurred in 2 cases. Although drainage of the cyst contents greatly facilitates removal, it also carries a risk of contamination; thus a traditional approach via a large craniotomy seems to be the safest choice.     

颅内微小动脉瘤的血管内治疗简

目的探讨血管内介入治疗颅内微小动脉瘤的疗效并进行分析。方法回顾性分析34例微小动脉瘤（共35个动脉瘤）病人的临床资料,均采用血管内栓塞治疗,其中栓塞加支架辅助治疗3例。结果动脉瘤完全填塞28个,瘤颈残留7个。术中无动脉瘤破裂,术后脑梗死8例。30例病人术后3个月复查DSA,残颈无增大表现而继续临床观察。随访34例,时间12个月,完全康复30例,遗留轻微神经功能障碍4例。结论对于已破裂的微小动脉瘤,在血管内介人治疗过程中,通过采取相应技巧,预防出血及缺血性并发症,可获得较好的临床疗效。