儿童脑室内囊肿的神经内镜治疗

目的 探讨神经内镜治疗儿童脑室内囊肿的技术要点与疗效,评估各类脑室内囊肿脑脊液循环动力学的变化.方法 利用磁共振脑脊液电影成像(Cine MRI)对17例脑室内囊肿患儿术前术后的脑脊液流速流量进行分析,探究内镜手术治疗各类脑室内囊肿最佳手术方法 和临床效果.术前诊断为侧脑窒囊肿8例,第三脑室囊肿2例,第四脑室囊肿4例,鞍上池囊肿2例,四叠体池囊肿1例.结果 术后Cine MRI显示所有患儿的脑脊液循环动力学较术前均有不同程度改善,17例患儿中有14例囊肿不同程度的缩小,3例无明显变化,囊肿缩小率达82.4%.无手术相关的严重并发症及死亡病例.随访3-19个月,无囊肿增大及造瘘几堵塞病例.结论 Cine MRi及同位素脑池显像有助于了解脑窜内囊肿患儿的脑脊液循环动力学变化,是制定内镜手术方案和判断手术疗效的重要参考.神经导航使内镜手术更加精确、安全.术后常规腰穿有利于重建脑脊液循环,改善患儿预后.

Neuro-endoscopic treatment for intraventricular cysts in children

Objective To study the technical key points and effects of neuro-endoscopic treatment for intravcntricular cysts in children, and to analyze the features of velocity and flux of cerebrospinal fluid in patients of intraventricular cysts. Method Cine MRI was used to analyze the velocity and flux of eerebrospinal fluid. Among all the cases,there were 8 lateral ventricles cysts,2 third ventricle cysts,4 fourth ventricle cysts, 2 suprasellar araehnoid cysts and 1 quadrigeminal cistern arachnoid cyst. The neuro-endoscopic operation was performed to all kinds of intraventricular cysts in order to study the indication, optimal process and clinical effects. Results The CSF dynamic states were improved in all patients. It was found that the CSF passed through the stoma after ETV in all patients. The contraction of cyst was found in 14 cases, and there was no notable change in 3 cases. The total effective rate was 82. 4%. There was no surgery -related serious complication. The cyst enlargement or stoma obstruction was not found in all patients after 3 -19 months follow-up period. Conclusions Cine MRI and radionuclide cisternography are helpful to understand the CSF dynamic states in children with intraventricular cysts and they are important references for surgery and determination of prognosis. Neuronavigated endoscopic surgery may be more precise and safe. Post-operative lumbar puncture is helpful to reconstruct normal CSF circulation and improve the prognosis.