第四脑室囊虫病诊断及手术治疗

目的：探讨四室脑囊虫诊断及治疗方治。方法：回顾分析1992年5月--2002年12月收治的四室脑囊虫21例，术前所有患者行头颅CT扫描，其中15例MR检查，21例患者行血清及脑脊液囊虫ELISA检查。所有患者术前1d行脑室外引流，均经枕下正中入路行四室囊虫摘除术，其中1例行脑室腹腔分流术。结果：CT扫描示四脑室呈囊性扩张且伴脑积水，MRI矢状位T1加权像示四室完整的包囊。血清囊虫ELISA检查19例阳性，脑脊液21例阳性。所有患者术后高颅压症状均立即解除，随访27．4月未见复发。结论：MRI是诊断四室脑囊虫最准确的方法。血清囊虫-ELISA检查简便，但脑脊液检查比血清更敏感。术前脑室外引流很有必要，枕下正中入路四室囊虫摘除术是有效的治疗方法。

Disgnosis and operational treatment of cerebral cysticercosis patients

Objective To determine the diagnosis and treatment of neurocysticercosis of the fourth ventricle Methods During a recent 10-year 21 cases of fourth ventricle cysticercosis have been evaluated and successfully treated CT images in all cases and MRI in 15 patients were observed preoperatively The enzyme-linked immunosorbent assay(ELISA)of serum and cerebrospinal fluid were performed in all patients Therapeutic drainage of lateral cerebral ventricle was undergone the day before operation Fourth ventricular cysts in all patients was removed by the suboccipital open route with aspiration Results The fourth ventricle saccular dilatation and obstructive hydrocephalus was shown on CT scan Integra1 cyst wall or scolex was shown on magnetic resonance imaging in T1-weighted the sagittal plane Result for ELISA were positive in 19 of serum and 21of cerebrospinal fluid The symptoms of intracranial hypertension were immediately relieved after craniotomy in all cases Mean post-therapy follow-up periods for this series exceed 27 4 months Conclusion The most valuable diagnostic tests are magnetic resonance imaging of the brain and ELISA of serum and/or cerebrospinal fluid It is necessary that drainage of lateral cerebral ventricle is performed preoperatively This experience indicates that direct excision by the suboccipital open route is the treatment of choice for fourth ventricle cystic lesions