神经内镜造瘘术治疗小儿鞍上池蛛网膜囊肿（附15例报告）

Treatment of suprasellaer arachnoid cysts in children with neuroendoscopy

目的探讨脑室囊肿造瘘联合囊肿桥前池造瘘术（VCC）在治疗小儿鞍上池蛛网膜囊肿（SACs）的有效性和安全性。方法总结2008年1月至2011年10月天津市环湖医院收治的15例小儿鞍上池囊肿患者，全部病例应用神经内镜脑室囊肿联合囊肿脑池造瘘手术，手术前后进行对比分析，评价指标包括脑积水症状缓解，鞍上池囊肿引起的内分泌改变，影像学脑积水缓解程度，囊肿缩小程度，视交叉和脑干恢复情况，导水管开放。结果全部病例造瘘手术顺利完成，术中观察到导水管开放，术后脑积水症状改善明显，内分泌症状中多饮多尿缓解最明显，影像学检查脑积水缓解，囊肿缩小，视交叉位置下降并后移，脑干位置部分恢复，造瘘口和（或）导水管可见脑脊液流动影像，上述指标术前后对比差异有统计学意义。结论神经内镜囊肿造瘘沟通脑室和囊肿以及囊肿与脑池的手术方式有效地解决了由鞍上池囊肿引起的各类症状，该术式有效且安全。

Objective To investigate the effectiveness and safty of the ventriculocystostomy （VC） combined with cystocisternostomy （CC） in dealing with the suprasellae arachoid cysts （SACs） and secondary hydrocephalus. Methods 15 pediatric patients with SACs and secondary hydrocephalus were admitted into Tianjin Huanhu Hospital during Jan. 2008 to Oct. 2011. They received operation with neuroendoscopy to make fenestrations to communicate the suprasellar cyst with lateral ventricules and the prepontine cistern named ventriculocystocister nostomy （VCC）. The outcomes were analyzed contrastively with several indexes, such as neuroendocrine symptoms improvements, shrinkage of the cyst, replacement of the pontine, optic chiasm and the opening of the Sylvian aqueduct. With the method of MRI - cine, the CSF flowing could be observed at the inferior fistula ora and/or Sylvian aqueduct. Results The operation were achieved and symptoms of hyhrocephalus were released in all patients. Intraoperatively, opening of Sylvian aqueduct was found in most of the patients. Among all neuroendocrine symptoms, the diabetes insipidus improved most markedly. The indexes evaluating the effectiveness of the VCC showed remarkably difference between post and pre - operation. Conclusions The procedure of VCC is effective in dealing with the symptoms with few complications and signs derived from the SACs.