神经内镜手术治疗颅内表皮样囊肿26例

目的 总结神经内镜手术切除颅内表皮样囊肿的经验。方法 回顾性分析2015年7月至2020年12月神经内镜手术治疗的26例颅内表皮样囊肿的临床资料。结果 26例中,小脑幕下19例,小脑幕上7例。囊肿全切除19例,次全切除5例,部分切除。术后颅内压升高症状、三叉神经痛完全消失,77.8%(7/9)的听力改善,75.0%(3/4)的癫痫改善,66.7%(4/6)的视力改善。术后主要并发症为面神经麻痹、后组颅神经麻痹。术后随访8～56个月,平均32.8个月;术后6个月,GOS评分5分22例,4分4例;复查MRI,囊肿无复发或进展。结论 神经内镜手术切除颅内表皮样囊肿是可行的,效果良好。     

颅内表皮样囊肿

颅内表皮样囊肿义称肌脂瘤或珍珠瘤,是颅内咒天性外胚层来源的囊性肿瘤样病变,占颅内肿瘤的0．20％～1．80％、此类肿瘤好发于脑桥小脑角、     

神经内镜辅助显微手术治疗颅内表皮样囊肿

目的:探讨应用神经内镜辅助显微神经外科手术治疗颅内表皮样囊肿的疗效。方法:本组共12例,均为颅内胆脂瘤,手术采用神经内镜辅助显微神经外科手术进行治疗,在显微镜下切除大部分肿瘤后,再用神经内镜进行探查,切除残余肿瘤。结果:术后临床症状、体征均明显改善或消失,均未发生无菌性脑膜炎和迟发性颅内出血等并发症。结论:神经内镜辅助显微手术治疗颅内表皮样囊肿,有助于提高肿瘤全切率,提高手术疗效,降低手术并发症。     

神经内镜辅助显微外科治疗岩斜区表皮样囊肿

目的:探讨神经内镜辅助下的显微外科技术对治疗岩斜区表皮样囊肿的重要意义,就其手术入路选择和术中注意事项进行讨论。方法:应用神经内镜辅以显微外科技术治疗岩斜区表皮样囊肿28例,显微镜直视下力争切除绝大部分肿瘤,神经内镜辅助寻找显微镜无法看到的残余肿瘤组织并切除之。结果:显微镜下切除肿瘤后,对残存的肿瘤组织经神经内镜辅助均可做到全部切除,无手术死亡病例。结论:神经内镜辅助下的显微外科技术,可提高对岩斜区表皮样囊肿的手术全切率,减少并发症.对该病的预后十分重要。     

颅内表皮样囊肿显微手术疗效及并发症分析

目的 总结颅内表皮样囊肿的显微手术疗效与并发症防治经验.方法 回顾性分析18例颅内表皮样囊肿的临床资料,均行显微手术切除.结果 病变全切12例,次全切2例,少量囊壁残留4例.术后出现并发症11例,无死亡病例.术后随访3～5年,复发3例.结论 显微外科手术可全切除颅内表皮样囊肿,改进手术方法可减少术后并发症发生.     

神经内镜治疗颅内蛛网膜囊肿的疗效分析

目的对采用神经内镜治疗颅内蛛网膜囊肿(IAC)患者治疗效果进行分析。方法收集两家医院神经外科42例颅内蛛网膜囊肿(IAC)患者。其中未使用神经内镜的单纯显微外科手术(A组)24例,直接或配合使用神经内镜手术(B组)18例。通过临床病历资料的回顾性分析,对比是否使用神经内镜(A,B两组间)对患者手术住院时间、术后并发症、临床症状的改善、术后随访囊肿复发或变化等方面产生的相关统计学差异。结果符合纳入标准的42例患者,均采用了显微神经外科手术治疗,依据是否使用神经内镜又可分为2组:未使用神经内镜(A组),直接或配合使用神经内镜(B组)。术后大部分病人临床症状得到改善或控制,复查颅脑CT或MRI均显示囊腔较前有所缩小,手术疗效明显。B组术式在减少术后并发症和囊肿复发率及缩短手术和住院时间方面较A组有明显优势。结论神经内镜技术适应性广,疗效确切,是微创治疗颅内蛛网膜囊肿的发展趋势,可以缩短手术及住院时间,减少术后并发症,降低IAC复发率,值得提倡。     

应用神经内镜治疗颅内蛛网膜囊肿

目的 探讨应用神经内镜治疗颅内蛛网膜囊肿的适应证、手术方法和效果.方法 2009年6月至2011年11月,应用神经内镜治疗颅内蛛网膜囊肿51例,均行囊肿壁部分切除+囊肿与蛛网膜下腔和脑池造瘘沟通术.结果 51例症状消失,随访到37例,行CT和MRI扫描囊肿消失9例,囊肿体积缩小1/2以上18例,另10例缩小1/3.结论 神经内镜治疗颅内蛛网膜囊肿安全、微创、效果明确,应作为首选的治疗方法.     

神经内镜手术治疗颅内蛛网膜囊肿

目的 探讨神经内镜手术治疗颅内蛛网膜囊肿的手术指征、手术方法和预后。方法 回顾性分析26例采用神经内镜手术治疗的颅内蛛网膜囊肿，其中采用神经内镜下囊肿脑池造瘘和囊壁部分剥除18例，囊肿次全切除3例，囊肿脑室造瘘5例(1例尚行脑室腹腔分流术)。术后随访3个月-2年。结果 术前有症状的20例患者中，症状消失11例，改善7例，无变化2例，术后不能改善的症状主要是癫痫。有随访影像学复查结果的16例患者中，囊肿消失6例，缩小7例，无变化3例。结论 神经内镜手术是治疗颅内蛛网膜囊肿有效和微创的方法。     

内镜下手术治疗颅内囊性病变

目的：探讨应用神经内镜手术治疗颅内囊性病变的手术适应证和手术方法。方法：采用单纯神经内镜下及神经内镜辅助显微镜下手术切除肿瘤、囊肿,囊肿－脑室和囊肿－脑池造瘘等方法治疗颅内囊性肿瘤、颅内蛛网膜囊肿、透明隔囊肿、侧脑室内囊肿等囊性病变51。结果：囊性肿瘤全切9例,囊肿切除6例,蛛网膜囊肿囊壁部分切除加囊腔－脑池造瘘23例,囊肿脑室造瘘13例,25例于术后3个月复诊,疗效较好。结论：应用神经内镜可以通过颅骨钻孔或小的骨瓣开颅手术治疗颅内囊性病变,手术副损伤小,疗效可靠。     

神经内镜下治疗交通性脑积水13例临床分析

目的 探讨神经内镜下行三脑室底造瘘术治疗交通性脑积水的可行性.方法 13例交通性脑积水病人术前、术后行NPHS、腰穿测ICP,对结果进行统计学处理.结果 本组11例有效,2例无效,无死亡病例.术后NPHS平均提高3.50,脑脊液压力平均下降40.44 mmH2O,差异有统计学意义(P<0.05).复查头颅MRI:9例脑...     

神经内镜治疗颅内病变手术适应证探讨

目的 探讨神经内镜在治疗颅内病变中的作用及手术适应证的选择. 方法 对386例神经内镜手术治疗颅内病变患者的临床资料进行回顾性研究,并对神经内镜手术方法 的选择、术后疗效及优缺点进行分析. 结果 本组所有患者术后随访6～12月,临床治愈340例,症状好转40例,症状改善不明显5例,死亡1例.影像学复查颅内占位性病变285例中,全切除259例,次全切除26例,病变复发7例;脑积水101例中,脑室恢复至正常水平82例,脑室明显回缩18例,脑室回缩不明显1例. 结论 示采用神经内镜治疗颅内病变,如果能严格掌握手术适应证,则疗效满意.     

脊髓内表皮样囊肿的临床分析（附4例报告）

目的总结脊髓内表皮样囊肿的临床特点,探讨其手术时机、手术方式的选择。方法回顾分析2009年8月至2011年12月间收治的4例经手术和病理证实的脊髓内表皮样囊肿患者的临床资料。4例脊髓内表皮样囊肿中,3例位于胸腰段脊髓内,1例位于胸段脊髓内。结果手术采用后正中入路,在显微镜下操作,2例囊肿完全切除,2例术中残留部分囊壁。术后3例病人症状及体征均明显好转,1例病人好转不明显。术后随访1～29月,3例病人恢复正常工作,半年后复查MRI未见肿瘤复发;1例病人能自动下床活动。结论早期发现、早期诊治是脊髓内表皮样囊肿治疗成功的关键。显微手术技术的发展有助于完整切除囊肿,减少术后神经功能的废损率和囊肿的复发率。     

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.     

Surgical treatment of parapontine epidermoid cysts presenting with trigeminal neuralgia

We retrospectively reviewed the management of 49 patients with parapontine epidermoid cyst presenting with trigeminal neuralgia, emphasizing the importance of fully removing the tumor to relieve the trigeminal neuralgia. Clinical symptoms, MRI, the operative approach, and post-operative results were examined. Trigeminal neuralgia was noted in all patients. The mean duration from onset of symptoms to surgery was 18 months. Total removal was achieved in 23 patients, near-total removal in 21, and subtotal removal in five patients. However, all tumor capsule that adhered to the trigeminal nerve was completely removed. After the operation, 33 patients developed facial hypoesthesia, three complained of double vision, and two developed acute hydrocephalus. At six months of follow-up, all patients had recovered and returned to their normal lives. At 2 years of follow-up, one patient experienced pain recurrence and underwent another operation. Parapontine epidermoid cysts either encase cranial nerve (CN) V but with intact arachnoid between the capsule and the nerve, or compress and distort the nerve with tumor capsule adherent or attached to the nerve surface. Resecting the tumor capsule’s attachment to CN V is critical in relieving pain, even though this method may damage the nerve.     

Neuroendoscopic surgery of intracranial cysts in adults

OBJECTS: The purpose of this study was to describe the indications, surgical techniques and postoperative outcome of neuroendoscopic interventions in a heterogeneous group of intracranial cystic pathologies. PATIENTS AND METHODS: Between 1992 and 2003, 127 patients with symptomatic intracranial cysts and cystic tumours underwent neuroendoscopic treatment in our department. In 22 patients indication for surgery was colloid cysts, in 9 patients pineal cysts and in 3 patients cavum vergae cysts. Twelve arachnoid cysts, 10 cystic craniopharyngiomas, 2 Rathke's cleft cysts and 69 malignant cystic tumours were operated on. The patients' mean age was 45 years and their clinical presentations varied from typical signs of increased intracranial pressure to focal neurological deficits. RESULTS: One hundred and twenty-seven patients with intracerebral cystic space-occupying lesions were operated on using stereotactic frameless or frame-based endoscopic techniques. There was no operative mortality. The operative morbidity was 3.1% including 1 memory deficit due to fornix injury, 1 hemiparesis due to postoperative haematoma after lesion biopsy, 1 aseptic meningitis and 1 subdural fluid collection. CONCLUSIONS: Endoscopic interventions enable neurosurgeons to manage intracranial cystic lesions. Via the same approach, the obstructed CSF pathways may be restored and consequently the increased intracranial pressure diminishes. With the aid of stereotactic guidance or a neuronavigation system, access to the lesion can be gained rapidly and with high accuracy.     

Surgical treatment of intracranial dermoid and epidermoid cysts in children

Between 1956 and 1987 operations were performed on 36 patients below the age of 20 years for epidermoid and dermoid cysts of the central nervous system. Seventeen tumors were intracranial intradural lesions (47%): 12 were located in the supratentorial region (71%) and 5 were located in the infratentorial region (29%). Ten of these tumors (59%) were seated along the midline structures. The clinical presentation was consistent with the location of the tumors. The neuroradiological diagnosis was mostly made with the aid of pneumoencephalography, computed tomography (CT), nonionic contrast medium CT cisternography, and magnetic resonance imaging. Complete removal of the tumor contents was performed in all cases but one, although the completeness of removal of the tumor capsule could not be exactly estimated in some patients. At late follow-up only two tumor recurrences were observed. Radical removal of the tumor capsule of these congenital tumors, even when it is connected to vital neurovascular structures, seems advisable in patients who become symptomatic within the first two decades of life.