先天性蛛网膜囊肿手术治疗的体会

先天性蛛网膜囊肿是脑脊液积聚在脑池和脑沟的蛛网膜和蛛网膜下腔之间形成的一种非肿瘤性良性病变[1]。2000～2006年,我科治疗20例颅内不同部位症状性蛛网膜囊肿病人,现报告如下。     

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。     

神经内镜治疗颅内蛛网膜囊肿的手术体会(附12例分析)

1对象与方法我院2005年4月～2006年4月,应用神经内镜治疗颅内蛛网膜囊肿12例,其中男7例,女5例;年龄6～15岁,平均10岁。病程5个月～5年。临床表现：颅高压7例,癫疒间1例,颞部膨隆3例;外伤后偶然发现1例（同时伴额颞部硬膜下积液）。影像学检查示蛛网膜囊肿位于外侧裂8例,鞍上2例,侧脑室2例。不同程度脑积水3例。[第一段]     

应用神经内镜治疗中颅窝蛛网膜囊肿

目的:探讨神经内镜治疗中颅窝蛛网膜囊肿的有效性、安全性,为该类疾病的治疗提供新的方法和依据。方法:根据影像学的分型,采用神经内镜对16例中颅窝蛛网膜囊肿进行囊肿壁部分切除及造瘘术。结果:11例行囊肿壁大部切除及邻近脑池造瘘;5例行囊壁部分切除及邻近脑池造瘘。术后除1例出现动眼神经麻痹,1例出现硬膜下积液,2例发热外,大部分病例症状改善明显。结论:应用神经内镜治疗中颅窝蛛网膜囊肿手术创伤小,并发症少,疗效好。     

脊髓蛛网膜囊肿的显微手术治疗

一、临床资料本组共 2 8例 ,男 17例 ,女 11例。年龄 7～ 5 8岁 ,平均 32 4岁。术前病程 6个月至 12年 ,平均 2 1 6月。囊肿部位颈段 3个 ,胸腰段 19个 ,骶部马尾 6个。临床表现肌力障碍 2 8例 ,深感觉障碍 13例 ,浅感觉障碍18例 ,二便障碍 10例 ,自发疼痛 15例。有明显感染史者 2例 ,有外伤史者 4例 ,不明原因者 2 2例。本组 2 8例全部做ＭＲＩ检查 ,其中 3例呈蛛网膜囊肿样改变 ,有占位效应。其余 2 5例表现脊髓明显增粗 ,呈均匀低信号 ,常伴有多个囊腔。Ｔ2显示异常高信号 ,难以区分界限。强化扫描囊肿壁显示局限性强化。二、结果2 8例…     

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.     

神经内镜手术治疗外侧裂蛛网膜囊肿临床分析

目的探讨应用神经内镜手术治疗外侧裂蛛网膜囊肿的疗效。方法回顾性分析28例外侧裂蛛网膜囊肿的神经内镜手术治疗,其中单纯内镜手术3例,神经内镜辅助显微神经外科手术9例,内镜控制显微神经外科手术16例,随访6个月-2年。结果囊肿消失7例,明显缩小15例,无变化6例,头痛头晕症状明显好转者21例,视力明显好转3例;术后并发症包括术后发热6例,头痛呕吐10例,动眼神经不全麻痹1例。结论神经内镜手术治疗外侧裂蛛网膜囊肿的效果良好。     

外侧裂蛛网膜囊肿手术方式分析

目的 探讨外侧裂蛛网膜囊肿手术方式的选择.方法 南方医科大学南方医院神经外科自2003年3月至2008年8月共采用手术治疗外侧裂蛛网膜囊肿患者87例,按手术方式(单纯内镜下手术40例、内镜控制下手术19例、显微镜下囊肿切除术22例)的不同将患者分为单纯内镜组、内镜控制组和显微镜组(分流及混合手术患者6例未计入),回顾性分析患者的临床资料并比较上述3种手术方式的疗效和并发症的发生率.结果 3组患者的年龄、囊肿大小、术后并发症、病情好转和囊肿缩小情况差异无统计学意义(P>0.05),而显微镜组患者的手术时间[(143±36.0)min]、术中出血[(160±39.6)mL]均高于其它2组,差异有统计学意义(P<0.05),单纯内镜组[(97±26.8)min,(15±4.8)mL]和内镜控制组患者[(87±27.6)min,(18±5.7)mL]的手术时间和术中出血量差异无统计学意义(P>0.05).结论 内镜下手术治疗外侧裂蛛网膜囊肿所需时间短,术中出血少,优于显微镜开颅手术.     

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。     

Endoscopic management of quadrigeminal arachnoid cysts

Objective  Quadrigeminal cistern arachnoid cysts are rare lesions, accounting for 5% to 10% of all intracranial arachnoid cysts and 9% of all supratentorial localizations. We reviewed the patients with quadrigeminal arachnoid cyst (QAC) who were treated with neuroendoscopic intervention. Materials and methods  Seventeen patients with QAC had been operated on between 2000 and 2007 in our institution. Four patients had undergone shunting prior to neuroendoscopic surgery. There were nine girls and seven boys with age ranging from 7 days to 17 years (mean, 40 months). All patients had hydrocephalus. A wide ventriculocystostomy (VC) and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. An aqueductal stent was also placed in two of the patients. Psychometric evaluation was administered postoperatively when possible. Follow-up of the patients ranged from 6 to 96 months (mean, 51.8 months). Results  Of the 17 patients, 12 underwent endoscopic procedure as the primary surgery. Five patients had been previously shunted. Macrocrania and psychomotor retardation were the main symptom and sign in all infants with QAC. Older children presented with the symptoms and signs of intracranial hypertension. Of the eight patients who were 6 months old or younger, only one did not need a ventriculo-peritoneal (VP) shunt. Endoscopic procedures were successful in all patients older than 6 months of age (P = 0.005). Conclusion  The patients presenting in their infancy had a psychomotor retardation, and all patients except for one, younger than 6 months of age, needed a VP shunt. Neuroendoscopic procedure is effective particularly in the patients with QAC older than 6 months of age. Presented in part at the 34th Annual Meeting of International Society for Pediatric Neurosurgery, 10–14 September 2006, Taipei, Taiwan.     

Endoscopic treatment of suprasellar arachnoid cysts

Objective  Arachnoid cysts constitute 1% of all intracranial mass lesions not resulting from trauma. Suprasellar arachnoid cysts (SACs) are uncommon. Obstructive hydrocephalus is the most common cause of initial symptoms and occurs in almost 90% of the patients with suprasellar arachnoid cyst. We report on 17 patients with suprasellar arachnoid cyst who were treated with neuroendoscopic intervention. Materials and methods  Seventeen patients with SAC had been operated on between 1999 and 2007 in our institution. Five patients had previously undergone shunting procedures or craniotomy. Nine boys and eight girls ranged in age from 4 months to 17 years (mean 53.2 months). All patients had hydrocephalus. A wide ventriculocystostomy (VC) or a ventriculo-cysto-cisternostomy (VCC) was done by using rigid neuroendoscopes. Psychometric evaluation was administered postoperatively, when possible. Follow-up of the patients ranged from 6 months to 7 years (mean 41.6 months). Results  Of the 17 patients, 12 underwent endoscopic procedure as the primary surgery. VC only was performed in the first patient. In the remaining 16 patients, VCC was done. A slit-valve mechanism was observed in 14 patients. Three patients needed a VP shunt, despite a successful VCC. Three of five patients, younger than 1 year of age became shunt dependent and none of the patients older than 1 year of age needed shunting. In four patients presented with shunt malfunction, the shunts were removed after endoscopic surgery. Only one subject’s total score was under the normal IQ limits but her subtests scores were heterogeneous. However, there was marked discrepancy among her subtests scores. Conclusion  Endoscopic surgery should be the first choice in the management of SACs. Neuroendoscopic VCC is successful in the majority of the cases. Presented in part at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), 15–18 June 2005, Marburg, Germany.     

神经内镜顺向造瘘治疗枕大池蛛网膜囊肿

目的 回顾经我科神经内镜造瘘治疗的枕大池蛛网膜囊肿病例,根据脑脊液的流动方向明确提出其准确的造瘘位置.方法 根据病灶位置及局部脑脊液流动方向,27例手术指征明确的枕大池蛛网膜囊肿分别接受神经内镜囊肿-四叠体池造瘘或囊肿-小脑上表面蛛网膜下腔造瘘.术后定期进行临床及影像学随访.结果 将大枕大池误诊为枕大池蛛网膜囊肿1例,26例枕大池蛛网膜囊肿中7例接受囊肿-四叠体池造瘘、19例接受囊肿-小脑上表面蛛网膜下腔造瘘.术后平均随访时间14.5个月,症状改善率88％( 23/26),闭目难立征转阴率92％( 24/26),囊肿体积缩小率8％ (2/26),对4例脑积水患者同时行第三脑室造瘘术且术后脑室体积均恢复正常.结论 通过顺脑脊液流向对枕大池蛛网膜囊肿进行造瘘取得了理想的临床效果,因此认为重建脑脊液的正常循环是枕大池蛛网膜囊肿造瘘的根本目的.     

Huge arachnoid cyst incorporating choroid plexus

Background We report a rare case of arachnoid cyst incorporating choroid plexus. This 7-month-old girl presented with macrocrania. Magnetic resonance (MR) imaging disclosed a cystic lesion arising from the left prepontine cistern extending to the left middle cranial fossa.Methods First, we performed resection of the membrane microscopically and obtained an adequate reduction of the cystic size. However, 4 months after the first operation, the cyst was enlarged again, and bulging of the portion of the craniotomy was noted. Thus, we performed neuroendoscopic transcortical ventriculo-cyst-cysternostomy and confirmed the choroid plexus inside of the arachnoid cyst.Discussion Postoperative course was uneventful. This is the first reported case of choroid plexus within an arachnoid cyst, determined neuroendoscopically.     

椎管内脊膜囊肿的临床特征和治疗方法

目的 探讨椎管内脊膜囊肿的临床表现、诊断和治疗方法。方法 回顾性分析我院自2006年1月至2014年12月收治的39例椎管内脊膜囊肿（不包含骶管囊肿）患者的临床资料。结果 病变累及颈段3例,颈胸段1例,胸段11例,胸腰段18例,腰段5例,全椎管1例。本组35例行囊肿切除术,其中31例囊肿全切,4例囊壁大部切除;4例行囊肿-腹腔分流术。术中22例可见硬膜漏口并对漏口进行结扎或缝合外,或用自体脂肪或生物胶封闭。35例行囊肿切除术患者中,32例术后症状改善,3例无改善。4例行囊肿-腹腔分流术患者中,3例术后症状改善,1例无改善。术后随访3~6个月,影像学复查,囊肿均消失,均未见囊肿复发;39例患者术后Frankel 分级:C级6例,D级22例,E级11例;所有患者切口一期甲级愈合,无脑脊液漏,未有无菌性脑膜炎发生。结论 对于椎管内脊膜囊肿,MRI是首选的检查方法;手术是其有效方法;对于累及长节段脊髓的患者,开放手术难以全切时,可以考虑行囊肿-腹腔分流术以降低囊肿压力,缓解脊髓压迫。     

颅内蛛网膜囊肿-腹腔分流术后疗效长期随访分析

目的 探讨囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿的疗效.方法 回顾我院2003年1月至2005年1月62例囊肿分流手术治疗颅内蛛网膜囊肿患者,随访其CT及MRI结果,对其疗效进行了长期随访.结果 62例囊肿中46例(74％)位于侧裂,8例(13％)位于大脑凸面,8例(13％)位于幕下.所有患者接受了蛛网膜囊肿-腹腔分流术.术后平均随访时间6.5年(6-8年),59例患者影像资料显示囊肿大部消失或完全消失,占95％.与分流手术相关的并发症有16例,其中8例出现良性颅高压症状.结论 囊肿-腹腔分流术是一种简单有效、安全的治疗方法,但应严格选择其手术适应证,对术后可能的并发症也应予以充分的重视.     

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.     

Pseudotumor syndrome in treated arachnoid cysts

We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism — specifically, a disturbance of the cerebrospinal fluid circulation.