神经内镜治疗后颅窝囊肿合并脑积水31例分析  

Neuroendoscopic therapy for hydrocephalus caused by cysts of the posterior fossa

作　　者：刘华[1] 彭玉平[1] 漆松涛[1] 韦拳堂[1] 宋烨[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经医学杂志》2011年第8期817-821,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨神经内镜治疗后颅窝囊肿合并脑积水的诊治方法。方法回顾性分析南方医院神经外科自2004年4月至2010年8月收治的31例后颅窝扩大囊室合并脑积水患者资料，所有患者均经头颅CT和MRI证实。其中后颅窝真性蛛网膜囊肿19例，Dandy walker畸形5例，布莱克囊肿2例，肿瘤术后囊肿5例。依据不同手术方式分成内镜手术组（14例1、开颅显微镜手术组（9例）和分流手术组（8例），根据术后患者临床症状改善情况、影像学表现和相关并发症发生情况判定疗效。结果3组患者术后早期临床症状均有所改善。术后随访6个月～6年，复查头颅MRI显示28例患者后颅窝囊肿及脑室系统较术前有不同程度的缩小，其中内镜组有效率和并发症发生率分别为92．9％和14．3％，显微镜组分别为88．9％和33．3％．分流手术组分别为75．0％和50．0％。结论神经内镜是治疗后颅窝囊肿合并脑积水的一种安全、有效术式．相对显微镜下开颅手术和分流手术而言，操作灵活，并发症少，预后好，值得临床进一步推广。Objective To explore the process and technique of neuroendoscopic operation in obstructive hydrocephalus caused by CYSTS of the posterior fossa. Methods An analysis of 31 patients with obstructive hydrocephalus caused by cysts of the posterior fossa, admitted to our hospital from April 2004 to August 2010, was performed; CT and MRI were performed on these patients. Among all the 31 patients, 19 had arachnoid cyst of the posterior fossa, 5 Dandy-Walker malformations, 2 Blake＇s pouch cyst, and 5 cysts after resection of the tumor. Treatment efficacy was determined according to the improvement of clinical symptoms, imaging manifestations and appearing of relative complications. Results Endoscopic management （n=14）, microsurgery （n=9） and ventriculoperitoneal shunt （n=8） were performed. All the patients＇ postoperative hydrocephalus was alleviated in early stage of treatment. Subsequent follow-up, ranged from 0.6 to 6 years, revealed a sharp reduction of sizes of the cyst and ventricle system under MRI in 28 patients, with a total effective rate of87.1%. The effective rate and incidence of complications were 92.9% and 14.3% in patients performed endoscopic management, 88.9% and 33.3% in patients performed microsurgery, and 75% and 50% in patients performed ventriculoperitoneal shunt, respectively. Conclusion Neuroendoscopic procedure is a safe and effective technique for hydrocephalus caused by cysts of the posterior fossa; as compared with those with microsurgery and ventriculoperitoneal shunt, higher success rate and less operative complications are achieved in patients with endoscopic management.

关 键 词：脑积水 后颅窝囊肿 神经内镜 

分 类 号：R651.1[医药卫生—外科学]