颅内蛛网膜囊肿45例的手术治疗体会

目的 总结颅内蛛网膜囊肿手术治疗经验.方法 回顾性分析45例颅内蛛网膜囊肿患者的临床资料,总结手术方法.结果 神经内镜下囊肿壁部分切除及邻近脑池-蛛网膜下腔-脑室造瘘术34例, 显微镜下开颅囊肿壁切除术8例,囊肿-腹腔分流术3例.45例患者术后症状消失33例,改善10例,无变化2例.术后3～6个月复查CT或MRI,见囊...     

颅内蛛网膜囊肿的诊断与治疗

目的：探讨颅内蛛网膜囊肿（IAC）的诊断和治疗。方法：对我院1992年11月至2000年10月收治的IAC进行回顾性总结。结果：34例IAC的诊断以临床症状和体证结合CT及MRI检查,术后病理检查来确诊。18例行囊壁部分切除加囊腔与脑池蛛网膜下腔交通术,4例囊肿－脑室分流,9例囊肿－腹腔引流术,3例显微外科（包括使用内窥镜）囊壁全剥离术。术后随访症状体征基本消失。CT及MRI复查囊肿缩小或消失。结论：CT及MRI是IAC最主要及可靠的诊断方式,对小型囊肿及近中线的深部囊肿,MRI检查优于CT,凡囊肿伴有颅内压增高,引起神经系器质性或功能性障碍者均应手术,并尽可能切除囊壁,建立囊腔与邻近脑池、蛛网膜下腔或脑室、腹腔的交通。应用显微外科技术及内窥镜行囊壁全剥离是治疗囊肿的最佳方式。     

颅内珠网膜囊肿的诊断与治疗

目的 :探讨颅内蛛网膜囊肿 (IAC)的诊断和治疗。方法 :对我院 1992年 11月至 2 0 0 0年 10月收治的IAC进行回顾性总结。结果 :34例IAC的诊断以临床症状和体证结合CT及MRI检查 ,术后病理检查来确诊。 18例行囊壁部分切除加囊腔与脑池蛛网膜下腔交通术 ,4例囊肿 -脑室分流 ,9例囊肿 -腹腔引流术 ,3例显微外科 (包括使用内窥镜 )囊壁全剥离术。术后随访症状体征基本消失。CT及MRI复查囊肿缩小或消失。结论 :CT及MRI是IAC最主要及可靠的诊断方式 ,对小型囊肿及近中线的深部囊肿 ,MRI检查优于CT ,凡囊肿伴有颅内压增高 ,引起神经系器质性或功能性障碍者均应手术 ,并尽可能切除囊壁 ,建立囊腔与邻近脑池、蛛网膜下腔或脑室、腹腔的交通。应用显微外科技术及内窥镜行囊壁全剥离是治疗囊肿的最佳方式     

小儿颅内蛛网膜囊肿32例

目的：探讨小儿颅内蛛网膜囊肿病因、发病机制及治疗原则。方法：对伴有颅内压增高和（或）神经系统症状者手术显微镜下行囊肿壁切除，对全切有困难的应行囊肿与脑室或脑池之间的交通或囊肿－脑池及腹腔分流术。结果；术后随访５年３２例患者临床症状缓解，其中囊肿消失１４例，明显缩小１２例，６例部分缩小。结论：对小儿颅内蛛网膜囊肿手术成功的关键是囊壁全切除或充分打通与外界的交通。     

颅内病变104次分流术的并发症及疗效初探

本文通过对颅内病变104次分流术的分析认为:1.用分流管行分流术的术后感染和梗阻的发生率仍然很高,本组分别为27%、23%;2.脑室—静脉窭或脑室—心房分流术的效果优于脑室—腹腔分流术;3.带蒂大网膜颅内移植治疗颅内蛛网膜囊肿及婴幼儿硬膜下血肿效果最为显著,其次为治疗颅内巨大囊性颅咽管瘤和复发性囊性胶质瘤。因此认为,大网膜颅内移植是治疗颅内各种含液性及囊性病变的有效方法,其远期效果优为显著并优于分流术。     

脑室镜手术治疗颅内蛛网膜囊肿

目的探讨脑室镜技术手术治疗颅内蛛网膜囊肿的临床效果。方法对18例颅内蛛网膜囊肿患者运用脑室镜技术设计理想手术切口和入路行囊肿-脑池造瘘术或脑室-囊肿─脑池造瘘术。结果术后随诊3～18个月,18例患者症状改善或消失,囊肿影像明显缩小或消失。1例患者出现动眼神经麻痹经治疗后痊愈。结论脑室镜下行囊肿-脑池或脑室镜造瘘术,是治疗颅内蛛网膜囊肿的有效方法。     

神经内镜手术治疗颅内疾病48例分析

目的 :探讨神经内镜手术治疗颅内疾病的作用。方法 :应用神经内镜手术治疗48例颅内疾病。结果 :经随访 3～ 36个月。 1 2例脑积水 ,其中 8例行第三脑室底脚间池造瘘术 ,术后 7例有效 ,有效率 87.5 % ,4例行脉络丛凝固术 ,术后 3例有效 ,有效率为 75 %。6例透明隔囊肿行囊肿 -脑室造瘘术 ,术后均有效。9例蛛网膜囊肿 ,其中 6例行囊肿 -脑池造瘘及部分囊壁切除术 ,术后均有效 ,另 3例未完成内镜手术。 1 8例慢性硬膜下血肿 ,其中 6例行内镜下残留血肿清除及部分内包膜切除术 ,术后均有效 ,另 1 2例未完成内镜手术。 3例脑内囊性肿瘤 ,1例行内镜瘤结节切除 ,另 2例未完成内镜手术。结论 :神经内镜手术是治疗颅内囊性疾病的一种微创新技术 ,在侧脑室内囊性病变的治疗中有独特的优势 ,在脑浅表囊性病变中有一定的治疗价值 ,在脑内囊性肿瘤的治疗中有辅助作用     

脑实质内及大脑凸面蛛网膜囊肿的治疗

目的总结脑实质内及大脑凸面蛛网膜囊肿的治疗。方法分析我科于1998年6月～2009年8月期间共收治11例病例资料。结果术后囊肿腔消失5例,囊肿腔变小4例,无明显变化2例;术后癫痫发作消失4例,癫痫发作次数减少1例;无术中、术后死亡病例。结论颅内蛛网膜囊肿一般通过病史询问和头颅CT或MRI检查即能明确诊断;根据囊肿的大小、有无临床症状及囊壁与周围组织粘连程度等选择不同的治疗方法,大多能取得理想疗效。但术中应注意对周围组织和血管的保护、尽量切除囊壁、充分行囊肿与蛛网膜下腔或脑室之间的沟通。     

带蒂肌瓣内置术治疗颅内蛛网膜囊肿25例

目的 探讨颅内蛛网膜囊肿的手术指征和手术方式.方法 25例成年颅内蛛网膜囊肿患者,其中大脑半球18例,后颅窝7例.均行囊肿切除加带蒂肌瓣囊腔内置术,充分切除蛛网膜囊肿的囊壁,并尽可能将囊腔与蛛网膜下腔及周围脑池打通,采取带蒂肌瓣囊腔内置.结果 25例术后临床症状消失或改善,随访3个月至4年,囊肿消失19例,囊肿不同程度...     

颅内蛛网膜囊肿手术治疗的临床分析

目的:探讨颅内蛛网膜囊肿的手术治疗方式及其疗效。方法:回顾性分析72例手术治疗的颅内蛛网膜囊肿患者的临床资料,神经内镜下囊壁部分切除+囊肿-脑室或脑池造瘘术16例,显微镜下囊肿切除术4例,显微镜下囊壁部分切除+囊肿-脑池造瘘术32例,囊肿-腹腔分流术20例。随访6个月～6 a(平均2.2a)。结果:67例患者经治疗后症状改善,有效率93.1%,随访CT或MRI显示83.3%(60/72)幕上蛛网膜囊肿体积显著减小,幕下蛛网膜囊肿体积无明显变化但症状显著改善。结论:有症状的蛛网膜囊肿患者均应积极治疗。针对不同患者选择合适的手术方式对预后有重要意义。神经内镜手术创伤小、并发症少,应继续推广应用。     

Tarlov囊肿壁切除瘘口封闭后脂肪填塞治疗的临床效果研究

目的 研究骶管Tarlov囊肿临床特点及囊肿壁切除加瘘口封闭后脂肪填塞手术方式的临床治疗效果。方法 回顾性分析32例有症状的骶管囊肿临床和影像学特点,按Tarlov囊肿的类型不同,采取囊肿漏口结扎并囊壁切除,或囊肿壁大部分切除加神经根袖套的塑形,后用带蒂脂肪填塞囊肿遗留的残腔。结果 术后早期32例患者中28例症状缓解。出院后随访30例6～42个月(平均12月),复查MRI囊肿未见复发,28例患者症状消失或明显改善,2例仍存在骶尾部疼痛及麻木不适感,但不影响生活及工作。结论 对症状型Tarlov囊肿患者采取囊肿壁切除加瘘口封闭后脂肪填塞治疗的手术方式是安全有效的,值得临床推广。     

颅内蛛网膜囊肿外科治疗体会

目的：探讨颅内蛛网膜囊肿（IAC）有效的手术方式及手术指征。方法：30例IAC患者中，18例显微镜下行囊肿壁切除，并与脑池、蛛网膜下腔沟通，8例行囊肿．腹腔分流术，4例行单纯囊肿切除术。结果：术后复查头颅CT示囊肿基本消失或有不同程度缩小。结论：囊肿．腹腔分流术一般作为术后复发、高龄患者或婴幼儿的治疗手段；显微手术是大多数蛛网膜囊肿患者的首选治疗方法，切除囊肿并充分建立囊腔与脑池之间的交通是手术成功和防止复发的关键。     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

Treatment of intracranial hydatid cysts

Background  Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

Methods  We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

Results  Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

Conclusions  Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

     

神经内镜下经鼻蝶窦入路手术治疗鞍区症状性 Rathke 囊肿

目的：探讨症状性鞍区 Rathke 囊肿（RCC）的临床特点与神经内镜经鼻蝶手术的疗效。方法总结与分析所收治的9例 RCC 患者的临床资料。神经内镜下经单鼻孔-蝶窦入路进行手术,采用清除囊液加囊壁部分切除的方法实施治疗。结果患者临床症状均消失或者改善,无脑脊液漏、永久性尿崩与垂体功能低下,随访4～12个月,未见囊肿复发。结论采用神经内镜下囊液清除加囊壁部分切除的方法治疗 RCC ,能够有效缓解症状,具有并发症少、对内分泌干扰小的优点。     

腹腔镜下剥除卵巢巧克力囊肿后复发的相关因素研究

目的 探讨卵巢巧克力囊肿行腹腔镜下剥除手术治疗病例术后复发情况及相关因素.方法 选择我院2010年5月～2012年4月收治的卵巢巧克力囊肿行腹腔镜下剥除手术治疗病例96例进行随访及回顾性分析,记录患者卵巢巧克力囊肿复发情况,并进行相关因素的比较分析.结果 96例患者中复发12例,复发率12.5％.在各类因素中,ASF-r分期和组织粘连是影响卵巢巧克力囊肿术后复发的重要因素,轻度患者复发率7.89％,显著低于重度患者（30％）,囊肿壁与卵巢皮质组织粘连者复发率19.23％,显著高于无组织粘连者（4.55％）,差异具有统计学意义（P＜0.05）.患者婚姻状况、囊肿范围及囊肿最大径大小比较无统计学差异（P＞0.05）.结论 囊壁与卵巢皮质组织粘连是造成复发的重要因素,重度患者术后复发率高,建议腹腔镜手术应重视组织粘连和ASF-r分期的重度患者.     

Uncommon locations of hydatid cysts

Human echinococcosis remains a complex problem that may affect several organs, and requires mostly surgical management. We present two cases with uncommon locations of hydatid cysts that were successfully managed in our hospital during the last two years. The first case was a 62-year-old woman with a multicystic lesion in her right thigh that was radically excised, and histology confirmed the diagnosis of echinococcosis. The second case was a 78-year-old man with multiple large intraabdominal hydatid cysts that required a complex operation, including splenectomy, partial removal of the liver cyst wall and evacuation of the content, and excision of pelvic, mesenteric cysts, and suprahepatic cysts. Both cases have not shown any sign of recurrence to date. Since the disease is still endemic in certain parts of the world and pharmaceutical agents are not radical, specific surgical procedures remain the treatment of choice with good results and acceptable morbidity, mortality and recurrence rates.     

Sublingual gastric duplication cyst causing respiratory obstruction: case report

A four-month old girl presented with difficulty in feeding and respiratory obstructrion from a sublingual cyst. Respiratory obstruction was relieved by needle aspiration of the cyst, followed 14 days later by complete excision. Histology of the cyst wall confirmed it to be a gastric duplication cyst. Though the gastric mucosa has a high propensity to deviate to ectopic sites, sublingual location is uncommon. The treatment of such cysts is preferably complete excision. However, when the cyst wall is closely associated with vital structures, cyst mucosectomy or partial excision with stripping of the mucosa of the residual part may suffice.