中颅窝蛛网膜囊肿的临床特点及外科治疗

Clinical features of middle cranial fossa arachnoid cyst and its surgical intervention

目的 探讨中颅窝蛛网膜囊肿的临床特点及不同术式对其治疗的临床疗效.方法 回顾性分析第四军医大学西京医院神经外科自2001年5月至2008年5月收治的352例中颅窝蛛网膜囊肿患者（占同期收住的颅内占位性病变患者的2.58%）的临床资料、手术方式及预后情况,其中男性发病率明显高于女性（男：女为4.1∶1）,以左侧居多（左∶右为3.6∶1）,324例行囊肿切除术,28例巨大囊肿行囊肿-腹腔分流术.结果 术后平均随访3个月～3年.头痛就诊患者中75例（58.59%）术后头痛完全消失,41例（32.03%）明显缓解.癫痫发作患者中8例术后发作频率明显减少或程度减轻.行为异常、注意力不集中或学习困难患者中11例术后改善明显.头围增大和颞部局限性隆起就诊者术后头围及局部隆起无明显变化.影像学复查显示囊肿完全消失者46例（13.07%）,囊肿部分消失者257例（73.01%）,囊肿无明显变化者49例（13.92%）.结论 中颅窝蛛网膜囊肿的临床特点为男性、左侧多发,年龄愈小手术效果越好,手术仅部分切除壁层即可;囊肿巨大时行分流手术效果好,分流管以中低压为佳.

Objective o investigate the clinical characteristics of middle cranial fossa arachnoid cyst （MCFAC） and its therapeutic effects with different surgical methods. Methods Three hundred and fifty-two patients with MCFAC （about 2.58% of patients with intracranial space occupying lesion）,admitted to our hospital from May 2001 to May 2008, were chosen in out study; their clinical data,surgical approach and prognosis were analyzed retrospectively. The gender ratio of patient with MCFAC adopted resection of arachnoid cyst and arachnoid cyst-peritoneal shunt was performed in 28 patients.Results Follow-up was performed for 3 months to 3 years. The headache completely disappeared in 75 patients （58.59%） and partial remission in 41 （32.03%） after the operation. The frequency and degree of seizures obviously decreased in 8 of the patients with MCFIAC. Eleven patients with dystropy,attention-deficit disorder or difficulty of learning got improvement. The head circumference and local skull eminentia was stable. The cyst disappeared completely in 46 patients （13.07%）, partially in 257 （73.01%） and no changes in 49 （13.92%）. Conclusion The clinical features of MCFAC is that it mainly occur in the left side of male. The younger the patient with MCFAC is, the better the treatment effect in the surgical intervention is. good outcome can be achieved by resection of the parietal layer of arachnoid cysts. The indication of shunt with meso-low pressure shunt system is for larger arachnoid cyst.