儿童颅内蛛网膜囊肿伴发硬膜下出血的临床探讨(附10例报告)

Clinical study on intracranial arachnoid cyst with subdural hemorrhage in children(report of 10 cases)

目的 探讨儿童颅内蛛网膜囊肿(AC)伴发硬膜下出血(SDH)的临床特征及治疗策略。方法回顾性分析北京儿童医院2010年1月—2021年6月收治的10例颅内AC伴发SDH患儿的临床资料,并结合有关文献报道进行分析,论述该类患儿的起病诱因、发生机制、出生史、临床特征、治疗策略及争议,探讨处理对策及有剖宫产史AC患儿发生SDH的倾向性。结果 8例颞部AC患儿均有剖宫产史,1例额部AC患儿为顺产,1例枕大池AC为产钳助产;4例有轻型头外伤史,3例有低压分流术史,产钳助产史1例。手术治疗9例,包括单次手术5例,多次手术4例。钻孔引流共10次,成功4次;开颅术共4次,成功3次;分流术2次均成功。保守治疗1例成功。术后随访,AC缩小6例,变化不著4例;所有患儿原有症状缓解。GalassiⅡ或Ⅲ型AC伴发SDH的患儿均有剖宫产史。结论 多数患儿通过单次手术治愈,少数患儿需数次不同手术治疗;预后均良好。钻孔引流术更为常用。治疗策略应层次化、个体化。除了头部外伤,低压分流手术史也是儿童颅内AC伴发SDH的一个诱因。

Objective To investigate the clinical characteristics and treatment strategy of intracranial arachnoid cyst(AC)complicated with subdural hemorrhage(SDH)in children.Methods The clinical data of 10 cases of intracranial AC patients with SDH admitted to Beijing Children s Hospital from January 2010 to June 2021 were analyzed retrospectively.And combined with relevant literature reports,the predisposing factors,pathogenesis,birth history,clinical characteristics,treatment strategies and disputes of this kind of children were discussed.The treatment strategy and the tendency of SDH in AC children with cesarean section history were discussed.Results 8 cases of temporal AC had a history of cesarean section,1 case of frontal AC had vaginal delivery,and 1 case of cistern AC was forceps assisted delivery.4 cases had a history of mild head trauma,3 cases had a history of low-pressure shunt and 1 case had a history of forceps delivery.9 cases were treated by operation,including single operation in 5 cases and multiple operation in 4 cases.Burr-hole craniostomy were performed 10 times,4 times successfully.Craniotomy was performed 4 times,3 times successfully.Both shunt operations were successful.Conservative treatment was successful in 1 case.AC decreased in 6 cases and remained unchanged in 4 cases during follow-up.The original symptoms were relieved in all cases.GalassiⅡorⅢAC with SDH was associated with a history of cesarean section.Conclusions Most children are cured by a single operation,and a few need several different operations,and prognosis are all good.Burr-hole external drainage is more commonly used.And treatment strategies should be hierarchical and individualized.In addition to head trauma,a history of low-pressure shunt surgery is a risk factor for AC with SDH in children.