小脑幕裂孔下疝CT诊断和相关治疗问题

CT diagnosis and clinic of Tentorial Hernia

目的认识小脑幕裂孔下疝的CT征象。评价脑定位血肿抽吸术的作用。方法经临床诊断的小脑幕裂孔下疝75例均做CT检查。总结所有的CT表现。临床依据血肿的量和病情分别采取脑外科手术、脑定位血肿清除术和内科保守治疗。结果小脑幕裂孔疝CT表现为:鞍上池缩小闭塞(52/75),脚间池狭窄闭锁(22/75),环池缩小闭塞(48/75),四叠体池填塞(20/75),中脑变形移住(33/75),脑室扩张(7/75)。蛛网膜下腔出血(26/75)。出血量<30 ml 10例,行脑定位抽吸术。出血量30～60 ml,行脑定位抽吸术7例,脑外科手术5例。血肿量>60 ml 16例,脑定位抽吸术7例,外科手术9例。结论小脑幕裂孔下疝的CT表现有特征性,可以据此作出较早期的CT诊断,并可依据血肿的量,脑疝的程度及时采取不同的临床治疗措施,提高治疗效果。

Objective To improve recognition of early CT signs of Tentorial Hernia and to evaluate virtue of hematom suction. Methods 75 patients with Tentorial Hernia proved by clinic All CT signs were analyzed. According to quality of hematoma and patient's condition.clearance of intracerebral hematoma or CT-monitor stereotacetic aspiration or medical treatment were carried out respectively.Results CT signs of it included changes of suprasellar cisterna,cisterna emphraxis52cases (52/75), interpeduncular cistern marrow 22cases(22/75),,transposition and deformation if midbrain 33cases(33/75),dilatation of lateral ventricle eases(7/75),Subarachnoid hemorrhage 26cases (26/75), Tentorial Hernia are divided into frond hernia,back hernia, comtlete hernia or hoop hernia.They were 24/75,31/75,16/75,4/75 in the cases separately.10cases of hematomas between 20 and 30 ml were treated with CT-monitor suction,5 cases were operated.16cases of hematomas morn than 60 ml,7cases were treated with CT-monitor stereotactic aspiration,9cases were operated. Concluaion CT-signs of Tentorial Hernia have special feature.there may be few typical clinical manifestation in early hernia. Early diagnosis could be performed, and adopt proper therapy scheme.