儿童颅内蛛网膜囊肿破裂的治疗及预后  

Treatment and prognosis of ruptured intracranial arachnoid cysts in children

作　　者：张刚[1] 史航宇[1] 米伟阳 史永强[1] 李楠[1] 江彬[1] ZHANG Gang;SHI Hangyu;MI Weiyang;SHI Yongqiang;LI Nan;JIANG Bin(Department of Neurosurgery, Xi＇ an Children Hospital, Xi＇ an 710003, China)

机构地区：[1]西安市儿童医院神经外科,陕西西安710003

出　　处：《中华神经外科疾病研究杂志》2018年第3期219-223,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨儿童颅内蛛网膜囊肿(IAC)破裂导致硬膜下血肿或积液的病因,治疗及预后。方法回顾西安市儿童医院2011年9月至2016年12月间收治的13例儿童颅内网膜囊肿继发硬膜下血肿及积液患者,其中男10例,女3例(男∶女为3.3∶1),平均年龄5.1岁(1.8~12.4岁),回顾性分析患者的临床资料及随访情况。并结合文献探讨该疾病的病因、治疗及预后。结果本组13例患儿均得到随访,随访时间为3~40个月,平均随访22个月。13例患儿的高颅压症状如头痛、头晕、呕吐,视物模糊等症状均消失。影像学检查发现出血及积液均吸收或好转;3例囊肿消失,7例囊肿体积缩小,3例囊肿体积无变化。囊肿直径<5 cm的病例,临床及影像学预后好于囊肿直径>5 cm者。结论儿童IAC破裂继发硬膜下血肿或积液发病率不高,临床预后良好。手术治疗以解决颅内压增高为主要治疗目的,单纯颅骨钻孔外引流术应作为首选方案;如果患者症状仍不能改善,神经内镜辅助囊肿-基底池造瘘术对缓解症状有帮助,但并不能减少再出血的风险。囊肿初始的大小可能影响预后。Objective The etiology,strategies and prognosis of subdural hematomas or hygroma caused by intracranial arachnoid cyst rupture in children were investigated.Methods Thirteen cases of subdural hematomas or hygroma caused by intracranial arachnoid cyst rupture in children in our hospital from September 2011 to December 2016 were analyzed retrospectively.There were 10 males and 3 females with a mean age of 5.1 years old （ranged 1.8 ～ 12.4 years）.Results All the patients were followed up with a mean time of 22 months （3 ～ 40 months）.The symptoms of intracranial hypertension disappeared in 13 cases.Imaging examination showed that hemorrhage or hygroma approximatively disappeared or was improved including 3 cases of disappearance,7 cases of cyst decrease and no changing in only 3 cases.For the cyst with the diameter ＜5 cm,the clinical prognosis was better than those whose diameter ＞ 5 cm.Conclusion The incidence of subdural hemotoma/effusion induced by intracraninal arachniod cysts rupture was low and the prognosis is good.The surgical treatment is applied to reduce the intracranial hypertension and burr hole evacuation is a preferred choice.Endoscope-assisted cyst-suprasellar cistern fistulation is suggested if evacuation is not satisfactory,but it could not reduce the incidence of hemorrhage.The 0size of cyst is associated with the prognosis.If pre-operative symptoms persist after the evacuation,additional surgery might be considered.The minimally invasive neuroendoscopic approach is safe in our hands and offers good symptom control,but successful treatment may not reduce the risk of haemorrhage post-traumatic head injury.Final outcome of IACs accompanied by subdural hematomas or hygroma may depend on the size of cysts.

关 键 词：儿童 颅内蛛网膜囊肿 破裂 手术治疗 预后 

分 类 号：R726.1[医药卫生—儿科]