小儿后颅窝囊肿特点和治疗探讨

Characteristc and surgical treatment of posterior fossa cysis in children

目的探讨小儿后颅窝囊肿的临床特点、手术方式及疗效。方法回顾分析近10年内治疗的38例后颅窝囊肿病变患儿的临床资料。这38例患儿中行单纯囊肿-腹腔分流治疗13例,囊肿剥离开窗治疗14例(其中显微镜下剥离13例,内镜下剥离1例),神经内镜辅助下第三脑室底造瘘术结合分流术或囊肿剥离开窗治疗(联合手术组)11例(均为巨大囊肿合并脑积水者)。结果分流组再次手术率15.4%(2/13),囊肿剥离开窗组再次手术率7.1%(1/14),联合手术组再手术率18.2%(2/11)。术后平均随访3年以上,所有病人的囊肿均缩小。结论对小儿后颅窝囊肿治疗应根据囊肿部位、大小和脑脊液吸收功能情况制定以显微镜下囊肿剥离术为首选,配合内镜和分流术的个体化手术方案。

Objective To explore the individual surgical technique and mode according to the characteristics of the posterior fossa cysts （PFC） in children. Methods The clinical data of 38 children with PFC, of whom, 13 were treated by cystoperitoneal shunt（CPS）, 14 by cyst decoherence and windowing （CDW） and 11 with huge cysts complicated by hydrocephalus by endoscopic third ventriculostomy （ETV） and CPS or CDW, treated in recent 10 years were analyzed retrospectively. Results The reoperation rates in the children undergoing CPS, CDW, and ETV and CPS or CDW were 15.4% （2/13）, 7.1%（1/14） and 18.2%（2/11）. The long-term （mean, more than 3 years） fellowing up showed that the cysts diminished in all the children. Conclusions The individual surgical plan, in which CDW under the microscope is a mainly method to treat the cysts while the neuroendoscope-assisted shunt is a subsidiary way, should be made according to the region and size of the cysts and the function of absortion of cerebrospinal fluid in the children with PEC.