蛛网膜囊肿合并慢性硬膜下血肿十例临床分析

Clinical analysis of 10 patients of chronic subdural hematoma associated with arachnoid cyst

目的探讨蛛网膜囊肿（AC）合并慢性硬膜下血肿（CSDH）患者的临床特点及治疗策略。方法回顾性分析2012年1月至2015年9月天津医科大学总医院神经外科收治的AC合并CSDH患者10例，年龄18～37岁，平均（27.5±5.6）岁，所有患者均采用颅骨钻孔硬膜下血肿引流术，不处理AC的手术策略进行治疗。术后随访12～18个月。结果10例中AC位于单侧中颅窝底8例，位于大脑半球表面2例，10例的AC均与CSDH临近。9例术后恢复良好，1例术后复发再次行硬膜下血肿钻孔引流术，术后恢复良好。所有患者术后随访中临床症状均明显改善，术后6个月Barthel指数均在90分以上。结论颅骨钻孔硬膜下血肿引流、不处理AC的治疗策略对于AC合并CSDH患者疗效可靠。

Objective To investigate the clinical characteristics, pathogenesis and surgical strategy for the chronic subdural hematoma associated with araehnoid cyst （AC）. Method Ten patients of chronic subdura/hematoma associated with AC were retrospectively enrolled from the Neurosurgery Department of Tianjin Medical University General Hospital from January 2012 to September 2015, with a mean age of 27.5±5.6 years （ range, 18 - 37 years）. All patients simply performed a burr hole drainage of hematoma and left the AC intact, then followed up for 12 to 18 months after discharge respectively. Results In this study, the AC in 8 of 10 cases occurs in the middle cranial fossa, and the other 2 cases root in the cerebra/ hemisphere. The AC of 10 patients all locate near the hematoma cavity. Nine patients had a full recovery, and only one patient had a recurrent subdural hematoma with a secondary operation, then recovery in 3 months postoperation. All patients lived completely free of neurologica/ symptom and showed no recurrence in the follow-up period with a Barthel index more than 90. Conclusion Simply burr hole drainage of hematoma and leave intact AC achieves satisfied outcome and provides a reliable therapy strategy for chronic subdura/ hematoma associated with arachnoid cyst.