四叠体池蛛网膜囊肿分型与神经内镜治疗策略

Neuroendoscopic treatment of different types of quadrigeminal cistern arachnoid cysts

目的探讨应用神经内镜治疗不同类型四叠体池蛛网膜囊肿的方法、策略和疗效。方法北京世纪坛医院自2005年11月至2009年11月接受神经内镜手术治疗了12例四叠体池蛛网膜囊肿导致的梗阻性脑积水患者，并进行了分型、采取相应的治疗方案，同时对手术方式、并发症和疗效进行探讨和分析。12例患者平均年龄3岁7个月，均有不同程度的临床症状，其中Ⅱ型7例，Ⅲ型5例。术后随访6—24个月，且手术前后均行脑脊液电影成像检查。结果本组12例患者术后恢复良好，无颅神经进一步损伤症状，无脑脊液漏，无感染及死亡。术后3例硬膜下积液患者随访6个月后自行消失，间断发热7例，经对症治疗痊愈。囊肿及脑室形态明显缩小8例，轻微缩小3例。结论根据我们对四叠体池囊肿患者的分型，应用神经内镜实施不同手术方案，囊肿得到有效治疗，重建了脑脊液循环，神经导航使内镜手术更加精确和安全。

Objective To evaluate the method, strategy and efficacy of treating different types of quadrigeminal cistern arachnoid cysts （QCAC） with neuroendoscope. Methods A retrospective analysis was conducted for 12 QCAC patients with obstructive hydrocephalus. They were classified into 3 types and underwent neuroendoscopic operation at our hospital between November 2005 and November 2009. Their surgical approaches, complications and efficacy were analyzed. The mean age of first diagnosis was 3.7 years old. There were 7 type II cases and 5 type m cases with a varying level of symptoms. The follow-up period was 6 -24 months. Cine-MRI （magnetic resonance imaging ） examination was performed both pre- operatively and post-operatively. Results Among them, 12 patients recovered well without any occurrence of hemorrhage, paralysis, lower cranial nerve injury, cerebrospinal fluid leakage, infection or death. Subdural effusion occurred in 3 cases, but disappeared within 6 months. Severn feverish cases recovered after a symptomatic treatment. The shapes of cysts and ventricles almost returned to a normal level in 8 cases. Three cases of arachnoid cyst had a slight change. Conclusion In accordance with the QCAC patient types, different neuroendoscopic approaches can fully reconstruct the cerebrospinal fluid circulation. And the use of frameless navigation makes it more precise and safe.