外侧裂蛛网膜囊肿分型及神经内镜造瘘手术治疗  

Classification and neuroendoscopic managements of Sylvian fissure arachnoid cysts

作　　者：王飞[1] 孙涛[1] 周玮林 夭晓燕[1] 余化霖[1] 

机构地区：[1]昆明医科大学第一附属医院神经外二科,昆明650032

出　　处：《中国临床神经外科杂志》2016年第4期203-205,共3页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81260182;81560206);云南省科技厅联合专项研究基金(2012FB036;2012FB037)

摘　　要：目的探讨外侧裂蛛网膜囊肿（SACs）的分型方法及其相应神经内镜造瘘手术方式的疗效。方法按SACs内侧囊壁与外侧裂的关系分为三型：Ⅰ型,SACs内侧囊壁位于外侧裂外1/3;Ⅱ型,SACs内侧囊壁位于外侧裂中1/3;Ⅲ型,SACs内侧囊壁位于外侧裂内1/3或邻近脚间池。Ⅰ型和Ⅱ型采用神经内镜囊肿-外侧裂造瘘术,Ⅲ型采用神经内镜囊肿-脚间池造瘘术。结果本组收集SACs 34例,Ⅰ型4例,Ⅱ型9例,Ⅲ型21例。所有手术过程顺利,术后病理检查结果为IACs。术后随访14～38个月,平均20.2个月,SACs体积缩小率、症状缓解率及术后硬膜下积液或血肿发生率分别为68%、38%和12%。Ⅲ型SACs术后体积缩小率和症状缓解率均明显优于Ⅰ型和Ⅱ型（P〈0.05）;Ⅲ型硬膜下积液或血肿发生率均明显低于Ⅰ型和Ⅱ型（P〈0.05）。结论Ⅲ型SACs应首选神经内镜囊肿-脚间池造瘘术,Ⅰ型和Ⅱ型的囊肿-外侧裂造瘘术效果不佳可能与患侧外侧裂发育不良有关。Objective To guide the neuroendoscopic surgery for Sylvian fissure arachnoid cysts（SFACs） by proposing new SFACs classification principle.Methods Thirty-four SFACs were classified as three types including type Ⅰ（n=4）, in which the inner wall of SFACs located at the lateral one third part of Sylvian fissure, type Ⅱ（n=9）, in which the inner wall located at the middle one third part of Sylvian fissure and type Ⅲ（n=21）, in which the inner wall located at the medial one third part of Sylvian fissure or stretched to the cisterna interpeduncularis. Neuroendoscopic cyst-Sylvian fissure fenestration was applied to typeⅠand Ⅱ SFACs and neuroendoscopic cyst-interpeduncular cistern fenestration to type Ⅲ SFACs.Results Mean period of follow-up was 20.2 months in all the patients. The rates of cyst deflation, clinical symptoms improvement and subdural effusion or hematoma occurrence were 68%, 38% and 12% respectively in all the patients. The curative effect of the surgery including cyst deflation and clinical symptoms improvement was significantly better in the patients with type Ⅲ SFACs than that in the patients with typeⅠor Ⅱ SFACs（P〈0.05）. The subdural effusion or hematoma occurrence rate was significantly lower in the patients with type Ⅲ SFACs than that in the patients with typeⅠor Ⅱ SFACs after the operation（P〈0.05）.Conclusions The neuroendoscopic cyst-cistern fenestration should be considered first in the patients with type Ⅲ SFACs and the most optimal surgical treatment should be further studied in the patients with typesⅠand Ⅱ SFACs.

关 键 词：外侧裂蛛网膜囊肿 神经内镜造瘘术 分型 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]