神经内镜顺向造瘘治疗枕大池蛛网膜囊肿

Neuroendoscopic treatment of arachnoid cysts in cisterna magna via CSF - orientated fenestration

目的回顾经我科神经内镜造瘘治疗的枕大池蛛网膜囊肿病例，根据脑脊液的流动方向明确提出其准确的造瘘位置。方法根据病灶位置及局部脑脊液流动方向，27例手术指征明确的枕大池蛛网膜囊肿分别接受神经内镜囊肿-四叠体池造瘘或囊肿-小脑上表面蛛网膜下腔造瘘。术后定期进行临床及影像学随访。结果将大枕大池误诊为枕大池蛛网膜囊肿1例，26例枕大池蛛网膜囊肿中7例接受囊肿一四叠体池造瘘、19例接受囊肿一小脑上表面蛛网膜下腔造瘘。术后平均随访时间14．5个月，症状改善率88％（23／26），闭目难立征转阴率92％（24／26），囊肿体积缩小率8％（2／26），对4例脑积水患者同时行第三脑室造瘘术且术后脑室体积均恢复正常。结论通过顺脑脊液流向对枕大池蛛网膜囊肿进行造瘘取得了理想的临床效果，因此认为重建脑脊液的正常循环是枕大池蛛网膜囊肿造瘘的根本目的。

Objective To specify fenestration site for arachnoid cysts in cisterna magna according to CSF dynamics by reviewing these neuroendoscopically treated cases in our department. Methods According to lesion locations and CSF dynamics, twenty - seven cases surgically indicated were fenestrated to either of quadrigeminal cistern and supracerebellar cistern. Clinical and radiological relief were followed after operation as well as discharge. Results A case of Mega cisterna magna was misdiagnosed as arachnoid cysts. Quadrigeminal cistern fenestration was manipulated in 6 cases, supracerebellar cistern fenestration in the other. Average period for follow - up was 14. 5 months, 88% （23/26） of cases was relieved symptomatically,92% （24/26） reverted to negative Romberg sign, and 8% （2/26） deflated in cyst volume. Meanwhile four cases of obstructive hydrocephualus were normal in ventriclar shapes after third ventriculotomy treatment. Conclusions CSF - orientated fenestration for arachnoid cysts in cisterna magna has shown promising effects clinically. As a result, physiological pattern of CSF - circulation should be restored primarily for it.