手术治疗颅内蛛网膜囊肿效果及适应证

Operative treatment of intracranial arachnoid cyst: report of 55 cases

目的 探讨颅内蛛网膜囊肿 (IAC)有效的手术方式和适应证。方法 比较不同时期 5 5例颅内蛛网膜囊肿手术适应证、术式及其效果的跟踪随访。结果 外侧裂IAC 2 9例施行单纯囊肿 -腹腔分流或囊壁部分切除的有效率60 % ( 3 / 5 ) ,复发率 40 % ( 2 / 5 ) ;囊壁大部分切除加带蒂肌瓣附贴有效率为 78% ( 11/ 14 ) ,显效率 5 0 % ( 7/ 14 ) ,复发率 2 1%( 3 / 14 ) ;囊壁显微切除加广泛打开IAC周围蛛网膜腔池有效率 10 0 % ( 10 / 10 ) ,显效率 70 % ( 7/ 10 ) ,无复发。其他部位IAC施行囊壁大部分切除有效率 82 % ( 14 / 17) ,显效率 41% ( 7/ 17) ,复发率 2 4% ( 4 / 17) ,死亡 1例。无症状IAC 9例无一表现出确切的IAC症状和囊肿大小改变。结论 对有颅内压增高症、占位性局灶症状及出血者尽早手术治疗 ;显微切除囊肿 ,周围大血管旁蛛网膜腔池的充分解剖、沟通是手术成功的基础 ;消除畸形有利防止复发 ;带蒂肌瓣远期对囊液的吸收及防止囊肿复发作用非常有限 ;囊肿 -腹腔分流仅用于成人、身体耐受性差及囊肿切除复发者。

Objective To study the operation procedures and indication for intracranial arachnoid cyst (IAC). Methods\ Symptoms, operation procedures and outcomes were analyzed in 55 cases of IAC operated in different period. Results There were 29 cases with lateral fissure arechnoid cyst. The effective rate of cyst-abdominal cavity shunt or partial cyst resection was 60%(3/5) and the recurrence rate was 40%(2/5). The effective rate of subtotal cyst resection plus pedicled muscle attactment was 78% (11/14) and the distinct effective rate was 50%(7/14). The recurrence rate was 21%(3/14). The effective rate of microsurgical removal plus opening up arachnoid cavity and pool around IAC was 100%(10/10), with a distinct effective rate of 70%(7/10) and no recurrence. The effective rate of subtotal cyst resection of 17 IAC in other location was 82%(14/17), and the distinct effective rate was 41%(7/17). The recurrence rate was 24%(4/17). 1 case died. 9 cases of asymptomatic IAC did not show any symptom and change of IAC. Conclusions\ Early resecting cyst and opening up the arachnoid cavity and pool around IAC are important in patients with intracranial high press symptom ,occuping symptom and hemorrhage. Removal of malformation helps preventing IAC recurrence. Microsurgical removal of the cyst and dissecting and communicating the arachnoid acvity and pool around big blood vessel are importance for successful surgery. The role of pedicled muscle is limited in absorbing cyst liquid and preventing cyst relapse. The cyst-ventricavity shunting is only used in adult, in the debilitated patients and for relapse of IAC.