儿童颅内蛛网膜囊肿的外科干预

目的 探讨小儿颅内蛛网膜囊肿的治疗方法.方法 收治15岁以下颅内蛛网膜囊肿患者37例,其中手术切除囊肿壁同时打通颅底蛛网膜池12例,囊肿-腹腔分流术20例,神经内镜造瘘术5例.对患者术后症状体征改善、影像学囊肿变化以及术后并发症等进行回顾性对比分析.结果 37例患者神经系统症状和体征均有不同程度的改善.影像学随访结果表明无论是哪种方法均能够使囊肿有不同程度的缩小,脑组织膨隆比较理想.改善情况并未因手术方式的不同而存在明显的差异(P>0.05).但开颅手术组并发症发生率明显高于分流组和神经内镜组.结论 囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿具有近期效果明显和并发症少的优点.

Abstract：

Objective Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1 % of all intracranial space-occupying lesions.So far, the optimal method of treatment for symptomatic arachnoid cysts remains controversial.In this article,we want to find an ideal technique to deal with this condition.Method The hospital records of 37 consecutive patients with intracranial arachnoid cysts who were treated in Tianjin Huanhu Hospital between January 2004 and December 2009, were analyzed retrospectively.All the patients were children below the age of 15 years old with an average of 6, 7 years old.The diagnosis of arachnoid cyst was based on computerized tomography (CT) and MRI scan findings demonstrating a well-circumscribed and non-enhancing cystic lesion that had attenuation values similar to those of the cerebrospinal fluid ( CSF) and did not communicate with the ventricular system.They were divided into three groups as follow, group A ( 12 patients ) , open craniotomy; group B ( 20 patients ) , cyst-peritoneal shunting, and group C(5 patients), endoscopic fenestration.Results The symptoms and neurological signs were improved more or little in all the 3 group patients who accepted the neurosurgical treatment.There were no significant differences between among the 3 groups in releasing of the symptom and sign caused by cysts.On the other hand,there were high percentage of complications,including intracranial infections and subdural fluid collections in the group A.Conclusions The technique of cysto-peritoneal shunting is likely the optimal method for treating the intracranial arachnoid cysts in children.

The neurosurgical treatment of intracranial arachnoid cysts in child

Objective Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1 % of all intracranial space-occupying lesions.So far, the optimal method of treatment for symptomatic arachnoid cysts remains controversial.In this article,we want to find an ideal technique to deal with this condition.Method The hospital records of 37 consecutive patients with intracranial arachnoid cysts who were treated in Tianjin Huanhu Hospital between January 2004 and December 2009, were analyzed retrospectively.All the patients were children below the age of 15 years old with an average of 6, 7 years old.The diagnosis of arachnoid cyst was based on computerized tomography (CT) and MRI scan findings demonstrating a well-circumscribed and non-enhancing cystic lesion that had attenuation values similar to those of the cerebrospinal fluid ( CSF) and did not communicate with the ventricular system.They were divided into three groups as follow, group A ( 12 patients ) , open craniotomy; group B ( 20 patients ) , cyst-peritoneal shunting, and group C(5 patients), endoscopic fenestration.Results The symptoms and neurological signs were improved more or little in all the 3 group patients who accepted the neurosurgical treatment.There were no significant differences between among the 3 groups in releasing of the symptom and sign caused by cysts.On the other hand,there were high percentage of complications,including intracranial infections and subdural fluid collections in the group A.Conclusions The technique of cysto-peritoneal shunting is likely the optimal method for treating the intracranial arachnoid cysts in children.