后颅窝蛛网膜囊肿的神经内镜治疗探讨

目的 探讨神经内镜下后颅窝蛛网膜囊肿的治疗效果.方法 本组共40例病例经CT和MRI均证实为后颅窝蛛网膜囊肿,随机分成显微镜切除组和内镜治疗组,术前均行MRI相位对比电影法.术后根据患者临床症状、影像学表现及相关并发症等判定疗效,同时进行1-2年随访.结果 本组病例行显微镜下囊肿切除术15例,内镜下囊肿切除25例.术后临床症状均有所改善.术后复查头部MRI显示28例患者后颅窝囊肿较术前有明显缩小(94%),MRI相位对比电影显示第四脑室脑脊液流动恢复正常.随访1年,内镜组12例囊肿缩小,14例临床症状明显好转,总有效率为87%.显微镜组8例缩小,3例复发,10例临床症状好转,总有效率为53%.结论 神经内镜治疗后颅窝蛛网膜囊肿与传统的开颅显微镜手术比较,其操作简便,创伤小,手术安全,患者恢复快,手术并发症少,值得进一步推广.

Treatment of posterior fossa arachnoid cyst by neuroendoscopic surgery

Objective To evaluate the effectiveness and clinical significance of neuroendoscopic surgery for treatment of intracranial posterior fossa arachnoid cyst. Method 40 cases of intracranial posterior fossa cyst were treated by neuroendoscopic surgery and microscopic resection. Results 15 cases were treated by microscopic resection and 25 cases by neuroendoscopic surgery. The symptoms of all the patients were improved soon. MRI of 28 cases showed intracranial posterior fossa cyst decrease (94% ). MR PC Cine demonstrated the fluid velocity of fourth ventricle was normal. For endoscope group, the cyst size of 12 cases reduced and 14 cases recovered during follow - up period of 1 year. The effective rate of this group was 87%. However,for microscope group,the cyst size of 8 cases reduced and 10 cases recovered during follow -up period of 1 year. The effective rate of this group was 53%. Conclusions The method of neuroendoscopic treatment of intracranial posterior fossa cyst is simple,minimally invasive and safe compared with traditional microscope procedure. The patients suffer little and the complications are also decreased. It is worth further clinical application.