导航结合内镜治疗16例症状性透明隔囊肿

A retrospective analysis of treatment of 16 cases of symptomatic septum pellucidum cysts by application of neuronavigation assisted neuroendoscopic half ventriculostomy

目的探讨症状性透明隔囊肿外科治疗的手术指征和疗效。方法对16例神经内镜单侧造瘘治疗症状性透明隔囊肿患者随访分析。结果以颅高压症为表现者13例（4例伴癫痫）中，10例症状完全消失，3例偶有头晕；7例癫痫发作者，4例坚持口服抗癫痫药手术后3例末发作、1例偶发，3例未规律服药癫痫1例偶有发作、1例频发。复查CT或MRI透明隔囊肿缩小〈50％4例，50％～90％9例，〉90％3例，2例脑积水均消失。结论对症状性透明隔囊肿应用神经内镜行囊肿壁单侧造瘘术具有微创、安全、颅高压症状控制满意等优点，但癫痫症状缓解不理想。

Objective To discuss the techniques and significance of application of neuronavigation assisted neuroendoscopic treatment for symptomatic septum pellucidum cysts. Method Under the guide of neuronavigation, surgical plan including optimal skin incision and approach was accomplished in 16 cases with septum pellucidum cysts. During surgical operation, the trajectory of endoscopy was monitored and guided in real time and dynamically by neuronavigation system. （16 patients with symptomatic septum pellucidum cysts were given a cyst - lateral ventricle half ventrieulostomy via transcallosal and transventricular approach by using a neuronavigation assisted neuroendoscope. Results Improvement of symptoms was achieved postoperatively in all the 16 patients. Out of 13 patients with a sign of intraeranial hypertension, symptoms completely disappeared in 10 patients and improved in 3 patients. Seven patients with epilepsy had no recurrence in 4 patients. A follow - up was made in 16 patients for 6 -48 months （mean 22 months）. Re examinations of CT or MRI showed that the cysts had decreased in size by 〈 50% in 4 patients,by 50% - 90% in 9 patients, and by 〉 90% in 3 patients. The lesions completely disappeared in 2 patients with hydrocephalus. Conclusions The application of neuronavigation assisted neuroendoscopic cyst - lateral ventricle half ventriculostomy for symptomatic septum pellucidum cysts is a safe, effective, and minimally invasive method, but patient with epilepsy has poor effect.