神经内镜治疗颅内蛛网膜囊肿108例临床分析

Neuroendoscopic treatment of intracranial arachnoid cysts (report of 108 cases)

目的探讨神经内镜治疗颅内蛛网膜囊肿的效果,为蛛网膜囊肿的治疗提供参考。方法回顾性分析1998年5月至2010年5月使用神经内镜治疗的108例颅内蛛网膜囊肿患者的临床资料,总结并分析手术适应证的把握及手术效果。结果 108例均成功行造瘘术。短期内症状好转68例(63%,68/108),其中头痛、恶心及呕吐症状缓解40例(95%,40/42);年龄小于12岁74例中症状好转48例(65%,48/74),其余34例中症状好转20例(59%,20/34)。术后1周影像学结果示术前合并脑积水16例均明显缓解。手术并发症包括发热、硬膜下积液、皮下积液、动眼神经麻痹、颅内感染,除1例死于术后颅内感染外,其余经处理后治愈出院。94例随访3月,影像学检查示蛛网膜囊肿消失或缩小61例(64.9%,61/94),无变化33例(35.1%,33/94);临床症状较术前改善54例(57.4%,54/94),其中癫痫好转8例(44.4%,8/18);86例术后随访半年,影像学检查示蛛网膜囊肿造瘘术无效46例(53.5%,46/86)。结论神经内镜治疗颅内蛛网膜囊肿长期有效率不高,需严格把握手术适应证。

Objective To explore the application of neuroendoscopy to intracranial arachnoid cysts （IAC）. Methods The clinical data of 108 patients with IAC, who underwent neuroendoscopic treatment in our department from May 1998 to May 2010, were analyzed retrospectively. The operative indications and effects on IAC were summarized and analyzed. Results The fistulization was performed successfully in 108 patients with IAC. One patient died from intracranial infection after the operation. The Operative complications included fever, subdural effusion, subcutaneous hydrops and intracranial infection. The follow-up performed in 94 patients 3 months after the; surgery showed that the clinical symptoms were relieved in 54 patients with IAC （57.4%, 54/94）. The imaging examination performed in 86 patients 6 months after the operations showed that the fistulization failed in 46 （53.5%, 46/86 patients with IAC. Conclusions The effective rate of the neuroendoscopic treatment of IAC is not so satisfactory, and the indications of neuroendoscopic fistulization should be strictly controlled in the patients with IAC.