CT脑池造影动态扫描在蛛网膜囊肿诊治中的应用

Dynamic CT Cisternography in the Diagnosis and Treatment of Intracranial Arachnoid Cysts

目的应用CT脑池造影(CTC)动态扫描的方法对蛛网膜囊肿进行分类和治疗。方法共纳入74例症状性蛛网膜囊肿患者。其中38例患者在治疗前进行CTC检查。腰穿碘海醇注入蛛网膜下腔后的1、3、6、12、24及48 h分别行CT扫描,测量蛛网膜囊肿内及囊外蛛网膜下腔的CT值,评估囊内外脑脊液交通情况。另外36例对照组患者未行CTC,直接行手术治疗。结果根据CTC及动态扫描的结果,蛛网膜囊肿被分为3种类型:完全交通性,不完全交通性及非交通性囊肿。其中诊断为不完全交通性及非交通性蛛网膜囊肿的28例患者进行手术囊肿切除,其他10例完全交通性蛛网膜囊肿进行观察随访。在CTC组中,所有手术治疗的患者症状均有好转,10例观察患者中,9例患者症状有缓解或者未加重。在对照的未行CTC直接手术的36例患者中,有6例患者症状并未有改善。结论基于CTC动态扫描确定的3种蛛网膜囊肿类型,有助于其治疗方法的选择。在症状性蛛网膜囊肿患者中,完全交通性型可以不需要手术干预。

Objective To investigate the communication between intracranial arachnoid cysts and subarachnoid space using CT cisternography（CTC） and consecutive CT scans.Methods CTC were performed in 38 symptomatic patients with arachnoid cysts before treatment decisions were made.Consecutive CTC images were obtained 2 days after intrathecal omnipaque administrations.The enhancement in cysts was measured quantitatively and compared with neighbouring subarachnoid spaces.Patients with cysts showing early fillings（n=10） were followed up without surgeries.Whereas,patients with cysts showing non-early fillings（n=28） were given surgical treatment through craniotomy.Another 36 patients with arachnoid cysts were given craniotomy without CTC evaluation.Results Arachnoid cysts were classified into complete,incomplete and noncommunicating cysts based on the CTC results.The symptoms of all surgical patients with CTC evaluations were relieved.Only one patient without surgery showed clinical deterioration.In the 36 patients without CTC evaluation,6 patients did not gain benefit from surgeries.Conclusion The classification of arachnoid cysts based on CTC is useful for the diagnosis and treatment of intracranial arachnoid cysts.