后颅窝蛛网膜囊肿临床治疗分析  

Clinical analysis of treatment for posterior fossa arachnoid cyst

作　　者：王子德 朱玉辐 陆冬 朱一硕 马强 贾郡 路洋 杨长志 史梦乐 WANG Zide;ZHU Yufu;LU Dong;ZHU Yishuo;MA Qiang;JIA Jun;LU Yang;YANG Changzhi;SHI Mengle(The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学附属医院,江苏徐州221006

出　　处：《中国实用神经疾病杂志》2020年第9期798-802,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨后颅窝蛛网膜囊肿的治疗策略。方法回顾性分析后颅窝蛛网膜囊肿手术治疗患者15例,结合文献复习,对其治疗作分析。结果15例患者中,行开颅手术9例,囊肿腹腔分流手术6例。开颅术患者3例继发脑积水,再次行分流手术后缓解;分流术患者1例分流管位置不佳,1例未解决其继发脑积水问题而再次行脑室-腹腔分流术。随访3个月~2 a,8例囊肿变小,其中开颅组5例,分流组3例,1例复发。结论对症状性后颅窝囊肿可考虑手术治疗,其手术指征应严格把控。对有占位效应而无明显症状的儿童后颅窝囊肿患者,早期手术有助于脑组织发育,但手术指征仍有争议,具体手术与否应个体化考虑。传统开颅手术在后颅窝囊肿治疗中创伤大,效果欠佳,有继发脑积水风险。神经内镜手术逐渐替代传统开颅手术,成为后颅窝囊肿手术首选,囊肿腹腔分流为不可缺少的治疗选择。Objective To explore the treatment strategy of arachnoid cyst in posterior cranial fossa.Methods The clinical data of 15 patients with posterior fossa arachnoid cyst were analyzed retrospectively.Review the relevant literature,and make an analysis about its treatment.Results 9 cases of intracranial poterior fossa cyst were treated by microscopic resection and 6 cases by cyst peritoneal shunt.3 cases with craniotomy occurred secondary hydrocephalus,and relieved after shunt operation again.1 case with cyst peritoneal shunt occured shunt in poor position,and another 1 performed ventriculoperitoneal shunt for the problem of secondary hydrocephalus.All cases were followed up from 3 months to 2 years.8 patients occured reduction of cysts,including 5 cases in craniotomy group and 3 cases in shunt group.Recurrence occurred in 1 patient.Conclusion Surgical treatment may be considered for symptomatic posterior fossa cysts,and the surgical indications should be strictly controlled.For children with space occupying effect without obvious symptoms of posterior cranial fossa cyst,early surgery is helpful for brain tissue development,but the indications of surgery are still controversial,and the specific operation should be considered individually.Traditional craniotomy in the treatment of posterior fossa cysts is traumatic,the effect is not good,and there is a risk of secondary hydrocephalus.Neuroendoscopic surgery has gradually replaced the traditional craniotomy,becoming the first choice for posterior fossa cyst surgery,cyst abdominal shunt is an indispensable choice of treatment.

关 键 词：后颅窝 蛛网膜囊肿 外科手术 开颅术 囊肿腹腔分流术 

分 类 号：R651.11[医药卫生—外科学]