成人后颅窝巨大蛛网膜囊肿的诊断与手术治疗

目的 探讨成人后颅窝蛛网膜囊肿的诊断和治疗方法.方法 回顾性总结分析10例成人后颅窝巨大蛛网膜囊肿的临床资料和手术效果,10例全部采取开颅囊壁切除造口粘连松解术,并使之与第四脑室和蛛网膜下腔交通,1例同期行颅内多发性硬膜下积液钻孔引流术.结果 所有病人术后恢复良好,出院前症状改善6例,无变化4例.术后1周常规复查头部MRI,囊肿缩小、小脑部分复位6例.3个月后随访复查头部CT,无囊肿复发.其中小脑完全复位4例,大部分复位6例;脑积水消失、脑室恢复正常4例,脑积水减轻6例;临床症状消失7例,好转3例.结论 开颅在显微镜下获得囊肿腔与脑室及蛛网膜下腔的交通是避免后颅窝巨大蛛网膜囊肿复发和治疗脑积水的关键,手术效果良好.

The diagnosis and surgical operation for adult huge arachnoid cyst in the posterior cranial fossa

Objective To exploit the diagnostic classification and surgical measure for adult huge arachnoid cyst (AC) in the posterior cranial fossa. Methods Retrospectively analyzing 10 cases with the huge arachnoid cyst in the posterior cranial fossa in adults. A suboccipital midline approach was performed in all patients. Radical resection of the cysts under microscope and adequately opening the fourth ventricle and cisterna magna up to confirming resolution of CSF at the aqueduct of sylvius could be accomplished. 1 case was operated by drill-hole drainage surgery for chronic subdural effusion due to excess ventriculo-peritoneal shunt. Results All the patients have good recovery after the operation.The clinical preoperative symptoms were improved in 6 cases before discharge. The first MRI radiological evaluation was carried out 1 week routinely after operation. ACs were obviously contracted in 6 cases. The 3rd month for all patients revealed disappearance of most preoperative symptoms in 7 cases and improvement in 3 cases. 3 months after the operation CT scan showed that AC and hydrocephalus disappeared in 4 cases, obviously decreased in 6 cases. Conclusions communicating and radical removal of the AC located at the posterior cranial fossa acquire communication between the cysts and subarachnoid cavity as well as fourth ventriculus that showed the good clinical results for the treatment of hydrocephalus and could prevent from the relapse of the AC.