非交通性蛛网膜囊肿的诊断与神经内镜治疗  

The diagnosis and neuroendoscopic treament of noncommunicating intracranial arachnoid cysts

作　　者：李新钢[1] 王东海[1] 徐淑军[1] 李刚[1] 张元鹏[1] 姜政[1] 鲍修风[1] 

机构地区：[1]山东大学齐鲁医院神经外科,济南250012

出　　处：《中华神经外科杂志》2005年第2期91-94,共4页Chinese Journal of Neurosurgery

摘　　要：目的　探讨蛛网膜囊肿 (intracranialarachnoidcyst,IAC)的影像学分类、手术适应证和神经内镜治疗。方法　对 22例IAC病人行CT蛛网膜下腔脑池造影 (computedtomographiccisternography,CTC),选择非交通性蛛网膜囊肿 (noncommunicatingintracranialarachnoidcyst, NCIAC)病例,硬质内镜行NCIAC-脑池交通术或脑室广泛造瘘术治疗,术后进行随访。结果　经CTC检查,22例病人中 15例确诊为NCIAC病人,有确切的神经系统症状体征,神经内镜手术后NCIAC病例临床症状改善或消失。本组病人无手术死亡,仅 1例病人术后 3个月并发慢性硬脑膜下血肿,行钻孔引流术治愈。9例NCIAC病人CT随访示囊腔明显缩小,脑组织复位。结论　⑴CTC对IAC病人具有诊断特异性,运用CTC可将IAC病人分为交通性蛛网膜囊肿 (communicatingintracranialarachnoidcyst, CIAC)和NCIAC。⑵症状性NCIAC具有神经外科手术指征。⑶神经内镜下NCIAC-脑池交通术,操作简便, 微创,疗效肯定,术后并发症少。Objective To explore CTC classification,surgical indication and neuroendoscopic treament of IAC. Methods CTC examination was applied to select NCIAC cases in 22 patients with IAC. NCIAC cases were treated with neuroendoscopic fenestration between IAC and cerebral cistern/ventricle with rigid neuroendoscope. Results All the NCIAC patients had definite neurologic findings. Postoperatively , All the patients were improved or cured. Only one case sustained chronic subdural hematoma and was cured by burr hole with drainage of hematoma. Follow-up CT images of 9 NCIAC cases showed that the cysts were decreased markedly in size, most of the space around the cysts were replaced by normal cerebral tissue. Conclusions ⑴ IAC patients can be classified into CIAC and NCIAC cases. The technology of CTC is specific for making a final diagnosis of IAC .⑵ Neurosurgical indication for IAC is limited to NCIAC patients.⑶ In comparison with traditional treatments, neuroendoscopic cystic fenestration seems to represent an effective, minimally invasive, few complications and low risk surgical procedure.

关 键 词：病人 治疗 蛛网膜囊肿 诊断 IAC 神经内镜 脑池 通性 学分 结论 

分 类 号：R651[医药卫生—外科学]