小儿侧裂池蛛网膜囊肿伴发硬膜下血肿的手术治疗

Surgical treatment of children sylvian cistern arachnoid cysts complicated with subdural hematoma

目的探讨小儿侧裂池蛛网膜囊肿伴发硬膜下血肿的临床特点、手术适应证和术式选择。方法回顾性分析2005年7月至2015年8月，中国医科大学附属第一医院神经外科收治的50例小儿侧裂池蛛网膜囊肿伴硬膜下血肿患儿的临床资料，其中亚急性硬膜下血肿者20例，慢性硬膜下血肿者30例，所有患儿均行血肿清除、显微囊肿切除、脑池沟通术，术中尽可能全切囊肿壁，并与蛛网膜下腔、脑池相沟通。结果所有患儿手术过程均较顺利，术后未出现严重并发症。患儿术后原有症状及影像学表现均有不同程度的改善，平均随访5．7年无复发病例。结论小儿侧裂池蛛网膜囊肿可引发硬膜下血肿，一旦发生，适合行显微囊肿切除、脑池沟通、血肿清除术。

Objective To investigate the clinical characteristics, surgical indications and methods of children sylvian cistern arachnoid cysts complicated with subdural hematoma. Methods Fifty childhood cases of sylvian cistern arachnoid cyst complicated with subdural hematoma were retrospectively analyzed, who were all surgically treated in the First Affiliated Hospital of China Medical University from July 2005 to Au- gust 2015. Among them,20 childhood cases were subacute subdural hematoma,30 childhood cases were chro- nic subdural hematoma. All patients underwent microscopic cyst excision, cystocistern fenestration plus hema- toma removal surgery. During the surgery, firstly we resected the cyst wall tissue as far as possible, and then we communicated the cyst with subarachnoid space and cisterns, which could make the cerebrospinal fluid flowed unobstructedly. Results The course of every operation was smooth, and there was no severe compli- cation postoperatively. Original symptoms and imaging manifestation resolved or improved in all patients. During a mean follow-up period of 5.7 years, there were no recurrent cases. Conclusion Children sylvian cistern arachnoid cyst can induce subdural hematoma. In this situation, microscopic cyst excision, cystocistern fenestration plus hematoma removal surgery is safe and effective.