颅内蛛膜囊肿的认识和外科治疗研究进展

The research progress of the understanding and surgical treatment of intracranial arachnoid cysts

蛛网膜囊肿为颅内非肿瘤性液体积聚,在所有的颅内占位损害中占大约1%。先天性蛛网膜囊肿是蛛网膜异常分裂还是复制收集脑脊液样形成导致囊肿扩大,其机制还未确定。当患者由于蛛网膜囊肿引起癫痫发作、脑积水、颅内压升高、局灶性神经症状时,需要采取手术治疗。针对蛛网膜囊肿的手术选择有着很大的争议。从安全性和有效性上出发,应寻求蛛网膜囊肿患者最佳的治疗方式。部分或全部切除蛛网膜囊肿建立囊肿和基底池的沟通被认为是最佳的治疗外科方式。笔者认为神经内镜采用很小的颅骨钻孔进颅治疗蛛网膜囊肿同样安全有效而且创伤小,除非特殊情况避免把分流手术作为治疗首选。

Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1% of all intracranial space-occupying lesions.Congenital arachnoid cysts are maldevelopmental anomalies in which splitting or duplication of the primitive arachnoid membrane in the early embryonal life leads to collection of clear CSF-like fluid.The growth mechanism of cysts is uncertain.Patients with symptomatic cysts causing seizures,hydrocephalus,increased intracranial pressure,neurological impairment should be treated.It has controversy regarding the optimal surgical management.The authors aim to determine which treatment is the best operative intervention for patient with arachnoid cysts in view of effectiveness and safety.Partical or total removal of arachnoid cyst to establish commuicacation between the cyst and the basal cistern is considered the best surgical approach.The authors also describe that endoscopic procedures via a minimally invasive burr hole approach are effective and safe techniques.Generally bypass suigery is not taken as the first choice treatment.