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目的总结后颅窝表皮样囊肿的临床特点以及诊断和治疗经验。方法对23例后颅窝表皮样囊肿的临床表现、影像学结果、显微手术方法和治疗结果进行回顾性总结。结果本组平均年龄为35岁。主要的临床表现为颅神经受损、小脑或脑干受压、癫癎和颅内压升高。病灶位于第四脑室内、枕骨板障内、CPA、CPA-斜坡和 CPA-中颅窝底各为4、1、7、4和7例。CT 上均表现为低密度;MRI 上多数表现为 T_1加权低信号、T_2加权高信号,病灶周围无水肿征象。本组经枕下正中入路、枕下乙状窦后入路和幕上下联合入路手术各为5、11和7例。4例因为包膜粘连脑干行次全切除,余者全切除。术后常见的并发症为无菌性脑膜炎和暂时性颅神经麻痹。术后22例恢复良好,1例加重。平均随访5年,1例6年后复发再手术。结论通过显微神经外科手术,绝大多数的后颅窝表皮样囊肿可以做到全切除,且无术后严重的神经功能缺失。
Objective To summarize the clinical characteristics of posterior fossa epidermoid cysts and their diagnosis and treatment experience. Methods The clinical manifestations, imaging findings, microsurgical methods and treatment results of 23 cases of posterior fossa epidermoid cysts were retrospectively reviewed. Results The average age of this group is 35 years old. The main clinical manifestations of cranial nerve damage, cerebellum or brainstem pressure, epilepsy and increased intracranial pressure. The lesion was located in the fourth ventricle and in the occipital plate, with 4, 1, 7, 4 and 7 cases of CPA, CPA-slope and CPA-middle cranial fossa. CT showed low density; MRI mostly manifested as T_1 weighted low signal, T_2 weighted high signal, no signs of edema around the lesion. This group of suboccipitally inserted approach, suboccipital sigmoid sinus approach and supratentorial approach 5,11 and 7 cases respectively. 4 cases because of capsular adhesions brain subtotal subtotal resection, the remaining total resection. Common postoperative complications are aseptic meningitis and temporary cranial nerve palsy. Twenty-two patients recovered well and one patient got worse. The average follow-up of 5 years, 1 case of recurrence after 6 years of surgery. Conclusion Through microsurgical neurosurgery, the vast majority of epidermoid cysts in the posterior fossa can be completely resected without any severe neurological deficits.