儿童颅后窝囊肿合并脑积水内镜手术治疗策略.pdfVIP

儿童颅后窝囊肿合并脑积水的内镜手术治疗策略 朱广通胡志强黄辉关峰戴缤毛贝贝王劭恒康庄 首都医科大学附属北京世纪坛医院神经外科100038 【摘要】 目的探讨神经内镜手术治疗不同类型颅后窝囊肿的手术入路，技巧及疗效。 方法回顾性分析26例颅 后窝囊肿合并脑积水病人的临床资料。术前均行磁共振脑脊液电影成像(CineMRI)和同位素脑池显像检查。采用 幕下后正中入路内镜辅助显微手术3例；幕上经额皮质入路单纯神经内镜手术23例，其中单纯行三脑室底造瘘术 转l例，无明显变化2例。术后出现皮下脑脊液漏1例，无其它严重并发症。幕下入路手术患者中，囊肿体积缩小 l例，稳定1例，囊肿增大而改行幕上手术者l例。幕上入路手术患者中，术后1周复查CineMRI显示造瘘口均有 脑室体积稳定无扩大。结论幕上经额皮层入路单纯内镜手术对侵及小脑幕的颅后窝巨大囊肿，以及伴有中脑导水 管扩张的DR患者的疗效确切，可同期解决脑积水和囊肿的占位效应。 【关键词】中枢神经系统囊肿；脑积水；神经内镜 sand forthe cranialfossa combinedwith DiagnosiEndoscopicsurgerystrategyposterior cysts hydrocephalus Abstracts Todiscussthe andeffectsof to Objective operativeapproach，techniquesendoscopicsurgery treatdifferentof cranialfossa A ofthe26cases typesposterior retrospectiveanalysis cysts．Methods whose are cranialfossa combinedwithobstructive was diagnosisposterior cysts hydrocephalus inthe of 1 were CineMRIand NeurosurgerydepartmentBeijingShijitanHospital．A1patientsaccepted radionuclide examination casesreceivedthe cisternographypreoperative．3 operation through in 23 infratentorialearlier othercasesreceivedthe approach period，the supratentorial cortical ETV in7 cases，ETVand resectionofthe walis approachoperation，includingonly partial cyst tomake andventricleorcisterncommunicatedin16 All of cysts cases．Results intracranial are indifferent weaknessare in1 hypertensionimpr