蛛网膜囊肿合并慢性硬膜下血肿的治疗及临床分析

目的探讨蛛网膜囊肿合并慢性硬膜下血肿的临床特点及治疗方法。方法采用回顾性病例研究方法,对安徽省立医院神经外科2009年1月至2014年1月所收治的9例确诊为蛛网膜囊肿合并慢性硬膜下血肿患者进行分析,其中男6例,女3例,年龄1.5~60岁,平均23.9岁。临床表现为头痛患者8例;其中6例伴恶心、呕吐,1例伴有肢体无力,1例仅有肢体抽搐;有明确外伤史6例,无明确外伤史3例。结果9例患者中5例行颅骨钻孔硬膜下血肿引流术,5例患者术后均恢复良好,后出院;另2例行开颅硬膜下血肿清除并蛛网膜囊肿切除术,术后痊愈。2例患者行保守治疗,一月后复查头颅CT提示血肿较前缩小,患者无症状,未手术。9例患者分别随访10个月至4年,未再复发硬膜下血肿,生活质量可。结论蛛网膜囊肿合并慢性硬膜下血肿,常见于有头部外伤史的年轻患者。有明显临床症状者需手术治疗,并根据血肿量及是否合并囊内出血等,选择单纯做硬膜下血肿钻孔引流术还是同时开颅清除血肿并处理囊肿。

Clinical characteristics and treatment of arachnoid cyst combined with chronic subdural hematoma

Objective To investigate the clinical characteristics and treatment strategy for arachnoid cyst combined with chronic subdural hematoma. Methods Nine cases of arachnoid cyst combined with chronic subdural hematoma, who received treatment in our hospital from January 2009 to January 2014, were retrospectively analyzed. Among these patients, there were 6 males and 3 females, with a mean age of 23.9 years （ range, 1.5-60 years）. Headache was seen in 8 cases, of whom 6 had nausea and vomiting, 1 had limb weakness, and 1 had limb convulsion. History of head injury was found in 6 cases. Results Five of the 9 patients underwent burr-hole irrigation and drainage （BHID） and fully recovered. Another 2 cases received craniotomy and evacuation of subdural hematoma and arachnoid cyst and also fully recovered. The other 2 cases received conservative treatment ; cranial CT one month later revealed reduced hematoma, indicating that patients recovered without operation. All patients were followed up for 10 months to 4 years after discharge, and none had recurrent subdural hematoma. Conclusions Arachnoid cyst combined with chronic subdural hematoma is commonly found among young adults with a history of head injury. Patients with obvious clinical symptoms should receive surgery, and surgical decision concerning application of BHID or craniotomy and evacuation of subdural hematoma and arachnoid cyst depends on clinical manifestations including hematoma quantity and existence of hematocele.