颅内皮样囊肿诊治分析并25例报道

Analysis of diagnosis and treatment of intracranial dermoid cyst and report of 25 cases

目的总结颅内皮样囊肿的临床特点,探讨其诊疗策略。方法回顾性分析我科近10年来25例颅内皮样囊肿患者临床资料,其中囊肿位于小脑者10例(1例生长至颈2水平),鞍旁6例,鞍上1例,侧脑室2例(1例为双侧侧脑室各一囊肿),四脑室2例(1例为术后复发),颞叶2例,额叶1例,桥小脑角1例。患者均行手术治疗,分析总结颅内皮样囊肿的的临床表现、影像特点、手术方案、围术期管理及预后。结果 1例双侧侧脑室皮样囊肿患者行右侧侧脑室囊肿切除术,其余所有患者皮样囊肿均切除。术后4例合并无菌性脑膜炎,其中1例合并脑积水,行脑室腹腔分流术。所有患者均预后良好,随访9～116月未见复发。结论颅内皮样囊肿需手术切除,术中注意保护周围重要结构,避免囊内容物外溢,剥净囊壁,远期预后良好;若囊壁残留,需长期随访。

Objective To summarize the clinical characteristics of intracranial dermoid cyst and discuss its diagnosis and treatment strategy. Methods The clinical data of 25 patients with intracranial endothelioid cysts in our department in recent10 years were retrospectively analyzed. The cysts were located in cerebellum in 10 cases(1 case grew to second cervical spine level), parasellar in 6 cases, suprasellar in 1 case, lateral ventricle in 2 cases(1 case with bilateral ventricles each cyst), quadriventricle in 2 cases(1 case with recurrence after operation), temporal lobe in 2 cases, frontal lobe in 1 case and cerebellopontine angle in 1 case. All patients underwent surgical treatment. The clinical manifestations, imaging features, surgical procedures, perioperative management and prognosis of intracranial dermoid cysts were analyzed and summarized. Results One case of bilateral ventricular dermoid cyst underwent resection of right ventricular cyst, and all other patients underwent resection of dermoid cyst. Four cases were complicated with aseptic meningitis after operation,and one case of them with hydrocephalus underwent ventriculoperitoneal shunt. All patients had good prognosis and no recurrence were found during 9 to 116 months of follow-up. Conclusion Intracranial dermoid cyst should be resected surgically. During the operation, attention should be paid to protecting the surrounding important structures, avoiding the spillover of the cyst contents, removing the cyst wall, and the long-term prognosis is good. If the cyst wall residues, longterm follow-up should be carried.