手术治疗颞部蛛网膜囊肿合并慢性硬膜下血肿9例

Surgical treatments of temporal arachnoid cyst complicated with chronic subdural hematoma in 9 cases

目的探讨颞部蛛网膜囊肿合并慢性硬膜下血肿的可能机制及治疗方法。方法颞部蛛网膜囊肿合并慢性硬膜下血肿9例,根据蛛网膜囊肿的大小选择不同的手术方法;其中5例患者颞部蛛网膜囊肿较大,采用额颞骨瓣开颅手术将慢性硬膜下血肿清除,并将颞部蛛网膜囊肿的囊壁开窗造瘘;另有4例患者颞部蛛网膜囊肿较小,则行慢性硬膜下血肿钻孔引流术。结果 5例经额颞骨瓣开颅的患者术后痊愈,4例钻孔引流的患者中1例在术后1年内复发,经过再次行开颅血肿清除及囊肿切除后治愈。术后1个月复查头颅CT,见慢性硬膜下血肿消失,但是颞部蛛网膜囊肿仍然存在。结论颞部蛛网膜囊肿与慢性硬膜下血肿的形成密切相关,较大的颞部蛛网膜囊肿合并慢性硬膜下血肿可以采用骨瓣开颅清除血肿+蛛网膜囊肿囊壁造瘘术;而较小的颞部蛛网膜囊肿合并慢性硬膜下血肿可以采用钻孔引流术。

Objective To investigate the possible mechanisms and treatments of the temporal arachnoid cyst complicated with chronic subdural hematoma.Methods In 9 cases of the temporal arachnoid cyst complicated with chronic subdural hematoma,different surgical methods were selected according to the size of arachnoid cyst.For 5 cases,temporal arachnoid cysts were large,and we removed chronic subdural hematoma with frontotemporal craniotomy,then the drill and drainage was carried out to open the cyst wall of arachnoid cysts;for another four cases the temporal arachnoid cyst were small,we operated by drill and drainage only.Results Five patients with frontotemporal craniotomy were all cured after surgery.Of four cases with drill and drainage,there was one case relapsed within 1 year after surgery,and the patient was cured after that we removed the chronic subdural hematoma and arachnoid cyst with frontotemporal craniotomy.After 1 month reviewed by head CT,the chronic subdural hematomas were disappeared,but the temporal arachnoid cysts were still exist.Conclusion Temporal arachnoid cysts were closely related to the formation of chronic subdural hematoma.Large temporal arachnoid cyst complicated with chronic subdural hematoma could be removed by craniotomy and fistulation and the drill and drainage might be used for the small one.