小儿中颅窝蛛网膜囊肿合并慢性颅内血肿的个体化外科治疗策略

目的探讨小儿中颅窝蛛网膜囊肿合并慢性颅内血肿的影像学特征及个体化外科治疗策略。方法回顾性分析13例中颅窝蛛网膜囊肿合并慢性颅内血肿的临床资料。根据CT/MRI上血肿部位与囊肿的关系,分为2种影像学类型:囊内血肿型(囊内型)、硬膜下血肿型(硬膜下型),综合考虑影像学特征(包括影像类型、囊肿大小、中线移位程度)及年龄、临床表现等因素,制定个体化外科治疗策略,并评价疗效。结果 13例中,囊内型7例,硬膜下型6例,均采取个体化手术治疗,术后临床症状均消失,无感染、急性颅内出血以及死亡等并发症。除1例囊内型于术后10月出现双侧慢性硬膜下血肿复发外,余均未出现血肿复发。术后随访3月~8年,7例囊内型术后5例发现囊肿不同程度缩小(其中消失2例、缩小>50%2例、缩小>20%1例),另2例无变化;6例硬膜下型术后2例囊肿缩小>50%,另4例囊肿无变化。结论综合评估血肿与囊肿间的影像学特征(包括影像学类型、囊肿大小、中线移位程度等),结合患儿年龄、临床表现等因素,有助于个体化选择小儿中颅底蛛网膜囊肿合并慢性颅内血肿的外科治疗策略。

Individualized Surgical Treatment Strategy of Pediatric Middle Cranial Fossa Arachnoid Cyst Associated with Chronic Intracranial Hematoma

ObjectiveTo investigate the surgical treatment strategy of pediatric middle cranial fossa arachnoid cyst associated with chronic intracranial hematoma.Methods13 cases of clinical data of pediatric middle cranial fossa arachnoid cyst associated with chronic intracranial hematoma were retrospectively analyzed.All cases were classified into 2 imaging types as follows: intracystic type and subdural type.Individualized surgical treatment strategy was taken according to the imaging characteristics (including the imagical type, cyst size, midline shift) and factors such as age, clinical manifestation, and then evaluated the curative effect.ResultsAfter operation, the clinical symptoms of 13 cases were disappeared, and there were no infection, acute intracranial hemorrhage and death.The follow-up period ranged from 3 months to 8 years.7 cases of intracystic type in postoperative, a total of 5 cases of cyst shrink different level (disappeared in 2 cases, 2 cases of >50% smaller and 1 case of >20% smaller), the other 2 cases had not changed.6 cases of postoperative subdural type, 2 cases of cyst shrink >50%, there were no changes in the other 4 cases of cyst.Only one case with intracystic type had bilateral subdural hematoma recurrence ten months later.ConclusionComprehensive evaluation between the hematoma and cyst imaging characteristics (including the type of imaging, the cyst size, midline shift, etc.), combined with the factors such as age, clinical manifestation, must be helpful to individual choices in pediatric middle cranial fossa arachnoid cyst with chronic intracranial hematoma surgical treatment strategy.