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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。术前均行脑脊液磁共振电影成像(Cine MRI)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。结果术后颅高压症状均不同程度改善;肢体活动障碍好转1例,无明显变化2例;经腰椎穿刺释放脑脊液后,术后所有病人颅内压均降至正常水平。术后出现皮下脑脊液漏1例,无其他严重并发症。幕上入路手术病人中,术后1周复查Cine MRI显示造瘘口均有脑脊液通过。术后6个月,复查MRI显示囊肿缩小18例,无明显变化8例;脑室缩小11例,无明显变化15例。结论幕上经额皮质入路单纯内镜手术对侵及小脑幕的颅后窝巨大囊肿,及伴中脑导水管扩张的Dandy-Walker畸形疗效确切,可同期解决脑积水和囊肿的占位效应。
Objective To investigate the surgical approach, skill and efficacy of neuroendoscopic surgery for different types of posterior fossa cysts. Methods The clinical data of 26 cases with posterior fossa cyst complicated with hydrocephalus were retrospectively analyzed. Cine MRI and isotope brain imaging were performed before operation. In the middle of posterior approach, endoscopic assisted microsurgery was performed in 3 cases. In the supratentorial cortex, 23 cases were treated with endoscopic neurosurgery only. Results The postoperative symptoms of intracranial hypertension were improved to some extent. One case of improvement of limb movement disorder, no obvious change in 2 cases. After the CSF was released by lumbar puncture, the intracranial pressure of all patients decreased to normal level. Subcutaneous cerebrospinal fluid leakage occurred in 1 case, no other serious complications. Supratentomy surgery patients, 1 week after the review Cine MRI showed fistula have cerebrospinal fluid through. Six months after operation, MRI examination revealed 18 cases of cyst shrinkage, 8 cases of no obvious change, 11 cases of ventricular contractions and 15 cases of no obvious change. Conclusion The supratentorial cortical approach with simple endoscopic surgery can effectively solve the huge cyst of the posterior fossa of the cerebellar tentorium and the Dandy-Walker malformation accompanied by the dilatation of the aqueduct of the midbrain. It can solve the problems of hydrocephalus and cyst effect.