神经内镜在小儿颅内囊液性病变治疗中的应用

 中华小儿外科杂志2010年第31卷第九期

【摘要】目的  探讨神经内镜技术在小儿颅内囊液性疾病中的治疗应用，以及结合开颅术及分流术协同完成小儿颅内复杂畸形的手术治疗。 方法  2004年2月至2009年2月，105例患儿接受内镜手术，年龄3月～12岁。包括阻塞性脑积水53例，其中51例成功完成内镜下三脑室底造口术。脑内囊肿52例中有28例颞叶囊肿行镜下囊壁部分剥离术和脑池开放术，5例透明隔囊肿和5例侧脑室囊肿分别行囊肿-脑室造口术、3例鞍上及三脑室囊肿行囊肿剥离+三脑室底造口，幕下囊肿6例：其中内镜剥离1例，5例巨大囊肿合并脑积水者采取内镜结合分流或开颅显微镜下剥离术。幕上中线部位囊肿5例，囊肿部分剥离+开窗4例，1例多房打通结合囊肿腹腔分流术。结果  51例脑积水中，47例术后临床症状改善。52例颅内囊肿，术后随访2月-3年，总体缩小率占98%，颞叶囊肿缩小率100%，11例术后有硬膜下积液，7例随访好转，4例术后4月～1年出现慢性硬膜下血肿，行外引流术后愈，1例合并中枢感染者放弃治疗。结论：内镜手术在小儿颅内囊液性疾病的治疗中效果良好,可优先选择。

【关键词】脑积水；中枢神经系统囊肿

Intracranial neuroendoscopic procedures in the treatment of hydrocephalus or intracranial cysts in children  SUN Lian-ping, JIN Hui-ming, YANG Bo, MA Jie . Department of Pediatric Neurosurgery, Xin-hua Hospital Affiliated to Medical College of Jiaotong University, Shanghai, 200093, China

  【Abstract】Objective To explore the efficacy of intracranial neuroendoscopic procedures in the treatment of hydrocephalus or intracranial cysts in children. Methods  Between February 2004 and February 2009，105 patients aged from 3 months to 12 years old, who were performed intracranial neuroendoscopic procedures were enrolled in this study. The 105 patients consisted of 53 patients with obstructive hydrocephalus and 52 with intracranial cysts. Fifty-one of the 53 hydrocephalus patients underwent endoscopic third ventriculostomy,  One the 52 patients with intracranial cysts, different procedures were performed to remove the cysts and reconstruct the cerebrospinal fluid (CSF) circulation according to the location of the cysts: endoscopic cyst part-resection and cystocisternostomy were performed for the 21 patients whose cysts were in temporal region , ventricle-cystostomy for the 5 patients with cysts in septum and the 5 with cysts in paraventricular , septostomy for the 3 patients with suprasellar and third ventricle cysts; cyst part-resection and third ventriculostomy for the 6 with infratentorial cysts and 5 with interhemispheric cysts. Results After surgery, 47 cases with hydrocephalus had resolution or improvement of symptoms, the other 4 patients underwent ventriculoperitoneal shunt for postoperative CSF leakage. The 52 patients with intracranial cysts were followed up for 2 months to 5 years. The reduction of cyst size was achieved on 98% patients. All temporal cysts sizesdisappearad after surgery. Subdural hygroma occurred in 11 cases, of which, 7 were healed spontaneously, the other developed chronic subdural hematoma and healed after external drainage One patient with postoperative intracranial infection was gave up on further treatment. Conclusion The intracranial neuroendoscopic surgery is effective to treat the hydrocephalus or intracranial cysts in children.

发表于：2010-10-02 23:55