29例小儿颅内蛛网膜囊肿破裂临床分析

Clinical analysis of rupture of intracranial arachnoid cysts in children: a report of 29 cases

目的探讨儿童颅内蛛网膜囊肿破裂的临床特点及治疗方式。方法回顾性分析2010年1月至2017年1月29例颅内蛛网膜囊肿破裂及4例再破裂患儿(共33例次)的临床资料、治疗方式及疗效。29例患儿中,男23例,女6例,年龄(5.82±3.82)岁。17例有明确外伤史(58.6%)、27例有高颅压症状(93.1%)、影像学显示93.1%的囊肿位于中颅窝,蛛网膜囊肿破裂后形成硬膜下积液/出血22例、硬膜下血肿4例、囊内出血1例、硬膜下出血合并囊内出血2例。33例次中非手术治疗8例,积液(积血)外引流15例,神经内镜下造瘘4例,开颅清除血肿5例,蛛网膜囊肿-腹腔分流1例。结果共随访27例患儿,KPS评分均在90~100分,积液(或)积血完全吸收7例,明显较少9例,6例较少,5例稍多;蛛网膜囊肿消失6例,明显缩小5例,减少9例,无变化7例。结论儿童颅内蛛网膜囊肿破裂后易形成硬膜下积液/出血或血肿,其治疗方式的选择应综合评估患儿临床症状及影像学资料,对有高颅压症状合并硬膜下出血的患儿可选择钻孔外引流或血肿清除后择期造瘘,对不合并硬膜下出血的患儿可直接行囊肿造瘘术。

Objective To explore the clinical characteristics and treatments of rupture of intracranial arachnoid cyst (IAC) in children. Methods Retrospective analysis was conducted for clinical data of IAC rupture (n=29) and re-rupture (n=4), from January 2010 to January 2017. Treatments and prognoses were analyzed for different types of IAC rupture. There were 23 boys and 6 girls with an average age of (5.82±3.82) years. There was a definite history of trauma (n=17, 58.6%). And there were symptoms of intracranial hypertension (n=27, 93.1%). According to the imaging studies, cranial fossa was common (93.1%). IAC rupture was divided into subdural hygroma/ hemorrhage (n=22), subdural hematoma (n=4), intracystic bleeding (n=1) and intracystic & subdural hemorrhage (n=2). Treatments included conservative measures (n=8), burr hole (n=15), fistulization (n=4) and craniotomy hematoma clearance (n=5). Results Follow-ups were available for 27 children. The score of Karnofsky performance status (KPS) was 90-100 points. Some cases had mild symptoms and effusion/hematoma became absorbed completely (n=7), significantly less (n=9), less (n=6) and slightly more (n=5). And arachnoid cysts disappeared (n=6), significantly less (n=5), shrank (n=9) and remained unchanged (n=7). Conclusions Treatment of IAC rupture should be comprehensive evaluated by clinical symptoms and imaging data. For intracranial hypertension: with bleeding, burr hole drainage or craniotomy hematoma clearance may be selected. Without bleeding, fistulization with priority.