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.

Surgical treatment of intracranial arachnoid cyst and prevention of normal perfusion pressure breakthrough

Objective To analyze the result of surgical managements of intracranial arachnoid cysts （IAC） and investigate the protective measures and therapy methods of normal perfusion pressure breakthrough（NPPB） in IAC. Methods 37 patients with IAC underwent surgery, in whom 24 received partial resection and communication between cystic cavity and cistern, 3 received total resection and 10 received endoscopic surgery. Results The mean of follow up of seven months showed the symptoms and signs of 34 patients were improved significantly, 2 nonimproved and one died. 2 cases with large cystic and signs of skull compression in CT or MRI occurred NPPB. The cases received endoscopic surgery did not occurr NPPB. Conclusion Microsurgery is the first operative selection of IAC. Endoscopic surgery suit for patients with a high probability of NPPB. Head CT or MRI could supply a reference for the operation of IAC. Dehydration and hornlone therapy are effective in treating NPPB.