囊壁切除加囊腔屏蔽术治疗颅内蛛网膜囊肿

目的探讨颅内蛛网膜囊肿的有效手术方法。方法6例颅内蛛网膜囊肿术前均经CT和MRI检查确诊，并进行显微镜下囊肿大部切除加囊腔屏蔽术。结果6例病人中有1例术后24h内发生急性脑肿胀，并出现癫痫发作，经脱水及抗癫痫等对症治疗后症状消失，半年后复查头颅CT囊肿消失。结论显微镜下囊壁大部切除并囊腔屏蔽术是治疗颅内蛛网膜囊肿一种新的手术方法，因病例少，需在今后的工作中积累病例并对此手术方法的可行性进行进一步探讨。     

显微手术治疗颅内蛛网膜囊肿

颅内蛛网膜囊肿 (ｉｎｔｒａｃｒａｎｉａｌａｒａｃｈｎｏｉｄｃｙｓｔ,ＩＡＣ)是非肿瘤良性病变 ,约占颅内占位性病变的 0 .4 %～ 1.0 % [1] 。一般认为有症状的ＩＡＣ需手术治疗 ,手术方法较多 ,但并非全部有效 ,部分患者仍有复发。我科从 1998至 2 0 0 1年间收治有症状的ＩＡＣ患者 5 9例。其中 34例行常规开颅 ,ＩＡＣ囊壁肉眼大部分切除术 ,效果不甚理想 ,复发率较高 ,其余 2 5例行显微手术治疗 ,取得了较为满意的结果 ,现报告如下一、对象与方法1.临床资料 :本组男 18例 ,女 7例 ,年龄 15～ 4 8岁 ,平均31.5岁。病程 4周～ 5年不等。…     

颅内蛛网膜囊肿

报道３３例经头颅ＣＴ或ＭＲＩ确诊的颅内蛛网膜囊肿患者，幕上２２例，幕下１０例，侧脑室１例。２６例行囊壁部分切除＋囊肿脑池造瘘术，１例行囊肿腹腔分流术。近期疗效满意。指出行囊肿脑池分流是较理想的手术方法，并强调术中充分建立囊肿与脑池的交通是该手术的关键     

应用内窥镜治疗颅内蛛网膜囊肿

颅内蛛网膜囊肿是一种较常见的病变,以往开颅手术,风险及创伤较大.我们于1996年应用德国 生产的Storz硬质内窥镜治疗6例颅内不同部位蛛网膜囊肿,收到满意疗效,现报告如下.     

颅内蛛网膜囊肿的诊断与治疗

颅内蛛网膜囊肿（intracranial aracltnoid cysts，IAC）为非瘤性占位病变，主要位于颅中窝，其次为颅后窝，好发于儿童，病因多为先天性因素，外伤引起较为少见。随着CT及MRI的广泛应用。该病的发现呈上升趋势，人们对该病的认识也逐渐深入，但对其处理原则目前尚未达成一致。笔对我院1992年1     

颅内蛛网膜囊肿的治疗策略

目的 探讨颅内蛛网膜囊肿治疗策略.方法 作者回顾分析于2010年9月1日至2010年12月1日在北京天坛医院神经外科门诊诊治的有完整临床资料的47例颅内蛛网膜囊肿,无干预治疗25例,手术治疗22例,神经内镜下蛛网膜囊肿壁部分切除+囊肿-脑池造瘘术13例,囊肿-腹腔分流术7例,显微下切除囊肿壁术2例.结果 无干预治疗25例,平均随访38.9个月,囊肿无变化.神经内镜治疗组,囊肿消失1例,囊肿缩小50%以上12例;分流治疗组,囊肿消失1例,缩小50%以上5例,无变化1例;显微手术治疗组,囊肿1例消失,1例无变化.并发症:神经内镜组,1例发现硬膜下积液;分流组中3例脑组织包裹分流管,1例硬膜下积液.结论 大多数颅内蛛网膜囊肿行无干预治疗;神经内镜治疗与囊肿-腹腔分流治疗,效果相似,前者更安全、微创,并发症少,应作为首选的治疗方法.

Abstract：

Objective To investigate treatment strategy of intracranial arachnoid cysts. Method 47 cases of Intracranial arachnoid cysts from Sep 1,2010 to Des 1,2010 were analyzed. 25 cases received no intervention but follow. 22 cases received operation, 13 of 22 cases neuroendoscopic partial cystectomy and communication between cystic cavity and brain cistern; 7 of 22 cases cysts - peritoneal shunt, 2 of 22 cases cranioectomy for cystectomy. Results All the cases of no intervention group showed no neuron - imaging change,in endoscopic treatment group,cyst disappearance occurred to 1 case, 12 cases reduced over 50%. In cyst -peritoneal shunt group,cyst disappearance occurred to 1 case,5 cases reduced over 50%. In microscopic cystectomy group, cyst disappearance occurred to 1 case. But no change to 1 case. Conclusions Most of intracranial arachnoid cysts should be given intervention but followed, neuroendoscopy is a safe and effective method with minima invasion in the treatment of intracranial arachnoid cyst. It should be first choice.     

颅内蛛网膜囊肿的神经内窥镜治疗

我科自 1 998年 7月至 1 999年 8月采用神经内窥镜 ,对 1 3例颅内蛛网膜囊肿的治疗经验和体会报告如下。资料和文法1 .一般资料　本组 1 3例 ,男 1 1例 ,女 2例 ,年龄 3- 47岁 ,平均 1 5.7岁 ,其中 1 8岁以上 4例。表现癫痫 4例、头痛 4例、走路不稳 2例、多动 2例、月经不规则 1例。 CT或 MR显示囊肿分别位于外侧裂 6例、后颅窝 4例、顶部 2例、鞍旁 1例。囊肿大小为 3.0× 3.0× 2 .0 cm～ 7.5× 5.0× 7.0 cm。2 .手术方法　在全麻下用外径 6.5mm的硬质神经内窥镜。根据 CT或 MR的引导 ,于囊肿最近的部位颅骨钻孔 ,剪开硬膜 ,电凝并…     

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。     

颅内蛛网膜囊肿

本文就颅内蛛网膜囊肿的发病机制、诊断和治疗予以综述。     

四叠体池蛛网膜囊肿

目的:探讨四叠体池蛛网膜囊肿的临床特征和治疗方法。方法:对11例四叠体池蛛网膜囊肿进行了回顾性总结分析。所采用的手术方法有:①脑室分流手术;②囊肿-腹腔分流术;③囊肿切除;④囊肿切除加囊肿-脑池分流术,或囊肿部分切除(即囊肿开窗术),或囊肿切除加脑室-脑池分流术。结果:其主要临床表现以颅内压增高症和中线综合征为主。上述方法中单纯囊肿壁切除只能使部分病人的病情缓解,脑室分流或囊肿切除加脑室分流手术的疗效较好。结论:四叠体区蛛网膜囊肿常合并梗阻性脑积水,单纯囊肿切除不能解除多数病人的梗阻性脑积水。作者根据囊肿是否与蛛网膜下腔相通提出:对交通性蛛网膜囊肿采用单纯性脑室分流术,对非交通性者采用囊肿切除加脑室分流手术的治疗方法。     

颅内蛛网膜囊肿的诊疗策略

目的探讨颅内蛛网膜囊肿（IAC）的治疗策略。方法对48例CT诊断IAC病人结合临床表现、CT平扫以及CT蛛网膜下腔一脑池造影（CTC）来判断手术指征。结果26例行手术治疗,22例行保守治疗。行手术治疗的26例患者中,失访2例,24例术后症状改善或消失。未行手术治疗的22例患者中,失访6例,症状改善6例,症状仍间断发作,药物可控制但效果不佳10例。结论具有明显手术指征的患者行手术治疗;手术指征不明显,能够接受CTC检查且结果为非交通性蛛网膜囊肿（NCIAC）的患者行手术治疗;交通性蛛网膜囊肿（CIAC）、手术指征不明显不愿接受CTC检查、不能接受手术治疗的患者行保守治疗,随访观察。     

显微外科治疗颅内蛛网膜囊肿的疗效观察

目的 探讨显微手术治疗颅内蛛网膜囊肿的效果。方法 回顾性分析42例颅内蛛网膜囊肿患者采用显微手术治疗的疗效。结果 囊肿全切除23例,大部切除14例,部分切除加脑池交通术5例。术后复查CT,29例囊肿消失或明显缩小。平均随访1年,患者症状与体征均改善。结论 显微手术治疗蛛网膜囊肿疗效满意。充分建立囊腔与脑池和蛛网膜下腔的交通,是手术成功的关键。     

Spinal arachnoid cyst

Preoperative, operative and postoperative radiological examinations and operative notes of 31 patients with spinal arachnoid cyst operated on during 2002-2009 at the Institute of Medical Sciences, Banaras Hindu University, were evaluated. Sixteen patients were male and 15 were female. All patients were managed surgically: extradural arachnoid cysts were managed by excision and intradural arachnoid cysts were managed by marsupialization. There was no recurrence in the 4 years of follow up.     

Intracranial arachnoid cyst with subdural hematoma

A case of a middle fossa arachnoid cyst associated with a post-traumatic subdural hematoma is reported, where the inner membrane of the hematoma did not entirely cover the cyst surface. At operation a third cavity was detected between the arachnoid cyst and the hematoma and it is postulated that the subdural hematoma was consequent to the developmental anomaly. We have reviewed 72 cases in the literature and discuss the management of subdural hematoma in the presence of arachnoid cysts.     

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.     

手术治疗颅内蛛网膜囊肿及其正常灌注压突破的防治

目的 分析不同手术方式治疗颅内蛛网膜囊肿(IAC)37例的疗效,探讨手术治疗IAC时正常灌注压突破(NPPB)的预防措施及治疗方法.方法 24例行囊肿切除及脑池交通术,3例行囊肿切除术,10例行神经内镜下造瘘术.结果 术后平均随访7月,34例症状或体征有不同程度改善,2例无明显改善,1例死亡.2例发生NPPB(1例治愈,1例死亡),头颅CT或MRI提示囊肿较大,占位效应明显,有小脑幕上抬或颅骨变形、受压征象.内镜手术病例中未发生NPPB.结论 显微手术疗效确切,是大多数IAC的首选治疗方法;如预计发牛NPPB可能性较高,可行神经内镜下造瘘术;头颅CT或MRI可为选择手术方式提供参考;大剂量脱水、激素治疗对NPPB有效.     

Spinal extradural arachnoid cyst

The case of 16-year-old boy with a spinal extradural arachnoid cyst is presented. An extradural arachnoid diverticulum extending from T10 to L1 was excised totally with hemilaminectomy. Surgery caused prompt improvement of the neurological deficit. The pertinent literature is reviewed.     

Effective shunt-independent treatment for primary middle fossa arachnoid cyst

The results of a prospective study on excision of the outer and inner membrane for symptomatic primary middle fossa arachnoid cysts in children are presented. During the period 1982–1989, among 48 cases of cyst in various locations, 18 symptomatic patients were treated by excision of both the outer and inner membranes with an opening to the basal cistern. The mean patient age was 3.2 years. All patients were evaluated by examinations, including magnetic resonance imaging (MRI), X-ray computed tomography (CT), quantitative CT cisternography (CTC), digital substraction angiography (DSA), N-isopropyl-p[123]iodoamphetamine single-photon emission CT (IMP-SPECT) and IQ. All showed abnormal cerebrospinal fluid flow dynamics. Significant complications included massive subdural effusion in two patients and transient pulmonary edema in one. There were no recurrences during the follow-up period (mean 4.7 years). Two morphological types were noted: type I, the classical anteromedial type where the cysts are attached directly to the adjacent parasellar cisterns, and type II, the anterolateral type, where the diagonally concave anterior temporal lobe covers the adjacent cisterns, making wide opening difficult. Type I accounted for 78% of all cases, and the reduction of the cyst volume with clinical improvement was remarkable within 6 months after surgery. Angiographically, 22% of cases showed tapering and retrograde filling of the superficial middle cerebral vein. This pattern is not included in Hacker's normal variations [18] and suggest mild but chronic compression of the developing brain. Even in patients with hemispheric cyst, the reconstituted brain showed sufficient cerebral perfusion on SPECT, suggesting that the nature of this disease entity is reversible developmental arrest. These results confirm that excision is a safe, effective shunt-independent procedure for middle-fossa arachnoid cysts, especially for those of type I.     

颅内常见部位蛛网膜囊肿的神经内镜治疗研究

目的探讨颅内好发部位蛛网膜囊肿(IAC)的内镜手术治疗经验。方法对21例颅内蛛网膜囊肿患者的临床资料进行回顾性分析。其中12例中颅窝AC及3例鞍上池IAC患者选择内镜部分IAC切除+IAC-基底池穿通术,6例后颅窝AC患者中5例行内镜部分IAC切除+脑池穿通术,1例患者行内镜IAC大部分切除术。对患者术后症状、体征以及并发症进行分析。结果 21例患者(1例失随访)中症状消失9例,改善9例,无明显变化2例。影像学复查显示,IAC张力消失3例,与术前相比,囊腔缩小、脑组织膨胀饱满14例,无明显变化3例。结论 IAC部分切除+囊肿-脑池穿通术的治疗效果较好,应作为影像学检查示与脑池、脑室比邻的AC患者的首选手术方式。