颅内蛛网膜囊肿的手术方法研究

目的 探讨颅内蛛网膜囊肿的手术治疗方法 . 方法 回顾性分析68例手术治疗的颅内蛛网膜囊肿患者的临床资料,根据手术方式不同,分为4组:囊肿切除术17例(A组).囊肿-脑池沟通术25例(B组),囊肿-腹腔分流术20例(C组),脑立体定向手术6例(D组),对4种手术方式的疗效进行比较. 结果 术后随访3月以上,59例患者症状消失或改善,有效率86.8%.CT证实囊肿消失或缩小者51例(75.0%).术后发生颅内积气2例、颅内出血3例、伤口感染2例.不同术式比较:影像学有效率A组为11/17(64.7%),B组为21/25(84.0%),C组为15/20(75.0%),D组为4/6(66.7%);症状改善率为A组12/17(70.6%),B组22/25(88.0%),C组19/20(95.0%),D组6/6(100%).A组7例患者术后头痛,发生比例较高. 结论 对颅内蛛网膜囊肿应慎重选择手术适应证和手术时机.从安全性和微侵袭角度,绝大多病例应首选囊肿-腹腔分流术.

Clinical study of the surgical approaches for intracraalal arachnoid cysts

Objective To investigate the surgical approaches for treatment of intracraniai arachnoid cysts. Methods The clinical data of 68 patients undergoing surgeries for intracranial arachnoid cyst were retrospectively analyzed. According to the surgical approaches adopted, these cases were classified into 4 groups, namely group A with surgical cyst removal (17 cases), group B with cyst-cistemal fenestration (25 cases), group C with cyst-peritoneal shunting (20 cases), and group D with stereotactic surgery (6 cases), and the outcomes of the patients were compared. Results Follow-up for more than 3 months showed an improvement of the symptoms in 86.8% of the patients, and CT scan showed cyst volume reduction in 75.0% of the patients. The postoperative complications included pneumocranium in 2 cases, intracranial hemorrhage in 3 cases, and incision infection in 2 cases. Radiographic improvement was achieved in 11/17 (64.7%) of the patients in group A, 21/25 (84.0%) in group B, 15/20 (75.0%) in group C, and 4/6 (66.7%) in group D; Symptomatic improvement occurred in 12/17 (70.6%) in group A, 22/25 (88.0%) in group B, 19/20 (95.0%) in group C, and 6/6 (100%) in group D. The patients in group A showed a high incidence of headache [7/17 (41.2%)]. Conclusion Surgical indications and surgical timing should be carefully evaluated in the treatment of intracranial arachnoid cysts. In terms of surgical safety and minimal invasiveness, cyst-peritoneal shunting should be the primary choice in most of the cases.