颅骨板障巨大表皮样囊肿二例并文献复习

颅骨板障内表皮样囊肿是一种很少见的颅内肿瘤，近期我们收治了2例，经手术及病理证实。结合文献，对颅骨板障内表皮样囊肿的发病机理、临床表现、影像学诊断、以及手术和预后进行总结。     

儿童脑脊液漏引起枕骨板障内假性囊肿一例并文献复习

由于脑脊液漏产生的颅骨板障内囊肿非常罕见,成人和儿童均可发病,多数都有外伤史.目前国内鲜有报道,国外文献报道板障内液性囊肿约20余例.我院2012年收治1例无明确外伤史的小儿脑脊液漏继发枕骨板障内假性囊肿病例,现报告如下并作相关文献的复习.     

板障表皮样囊肿的诊断与治疗

目的探讨板障表皮样囊肿的临床特点、诊断与治疗方法。方法回顾性分析4例板障表皮样囊肿的影像学表现、术中所见及治疗结果，结合文献讨论其诊治方法。结果病变位于额部2例，顶部1例，颞顶部1例。头颅X-线示圆形或类圆形骨质缺损，边界清楚，有或无边缘硬化。CT平扫示颅骨局部破坏，内外板变薄、中断，囊肿呈不均匀低密度。MRI检查均呈长T1、长T2为主的混杂信号，FLAIR成像显示不均匀高信号。肿瘤全切3例，次全切1例。随访1-44个月，无肿瘤复发。结论板障表皮样囊肿的诊断与鉴别诊断主要靠影像学，尤其是磁共振FLAIR像有助于与蛛网膜囊肿或囊性坏死性脑肿瘤鉴别。治疗以手术切除为首选，预后良好。     

颅内表皮样囊肿

<正>颅内表皮样囊肿又称胆脂瘤或珍珠瘤,是颅内先天性外胚层来源的囊性肿瘤样病变,占颅内肿瘤的0.20%～1.80%。此类肿瘤好发于脑桥小脑角、基底池、鞍上等部位,亦可见于脑室和脑实质内,仅少数(约10%)位于硬脑膜外(以颅骨板障内多见)。颅内表皮样囊肿生长缓慢,位于颅内者具有沿蛛网膜下隙、脑池匍行性生长、塑形之特点,易包绕邻近神经和血管,发病     

先天性颅骨缺损伴脑室穿通畸形1例报告

我院于2005年12月收治1例先天性脑室穿通畸形伴蛛网膜囊肿及颅骨缺损患者，临床表现为发作性癫痫，行蛛网膜囊肿切除及颅骨缺损一期修补术，痊愈出院。病例报告如下。     

颅骨骨膜窦2例报告

颅骨骨膜窦(Sinus pericranii)又称“颅骨膜静脉囊肿”,临床上较少见。为一团无肌肉层的静脉血管或静脉血管瘤,紧密地与颅骨表面相粘连,并通过板障静脉与颅内静脉窦相交通。我院于1979年诊治2例,为手术及病理证实。现报告如下。     

蛛网膜囊肿切除及颅骨修补术治疗颅骨生长性骨折的临床效果观察

目的探讨蛛网膜囊肿切除及颅骨修补术治疗颅骨生长性骨折的临床效果。方法选取2013-01—2014-01于我院就诊的颅骨生长性骨折患儿22例,回顾性分析患者的临床资料,分析其手术治疗效果。结果术后患者均未出现死亡,随访3个月,仍无死亡患者;其中1例患者出现复发现象,该患者由于地震埋压,又进行性加重,导致颅骨骨折复发,复发率为4.55%,给予治疗后,随访6个月,患者均未出现复发和死亡;经过术后CT检查发现1例患者发生严重的脑积水现象,并给予积极治疗,取得满意度效果。并发症发生率为4.55%,取得满意的治疗效果,患者治疗前脑颅缺损评分均显示存在明显的神经功能障碍或不全,治疗后患者NIHSS评分明显降低,比较差异有统计学意义(P0.05)。结论颅骨骨折采用蛛网膜囊肿切除及颅骨修补术治疗能有效降低患者病死率,预防术后并发症和复发等现象,值得临床推广应用。     

颅骨板障内上皮样囊肿及皮样囊肿19例临床分析

颅骨板障内上皮样囊肿及皮样囊肿１９例临床分析王新生王集生信凯罗世祺我院自１９６６年至１９９５年共收治１９例，皆经手术及病理证实，治疗取得较好疗效，本文对其临床特点及治疗作一讨论。临床资料本组男９例，女１０例。年龄６～５７岁，平均２８．５作者单位：１０...     

颅骨钻孔切除2例颅内蛛网膜囊肿

众所周知颅内蛛网膜囊肿(intracranial arachnoid cyst,IAC)常用的手术方法有肌骨成型瓣开颅蛛网膜囊肿切除术、囊肿与脑池交通术和囊肿与腹腔分流术。我们从1995年11月起用单纯颅骨钻孔切除术治疗2例颅内蛛网膜囊肿,取得了满意的治愈效果。现报道如下。     

颅骨表皮样囊肿2例临床分析

颅骨表皮样囊肿(skull epidermoid cyst, SEC)是良性、先天性的肿瘤,由神经管闭合过程中细胞异常分化所造成.其主要生成在颅盖骨,多发生于板障内,内外板有不同程度的骨质变薄、分离和破坏[1].     

椎管内脊膜囊肿的临床特征和治疗方法

目的 探讨椎管内脊膜囊肿的临床表现、诊断和治疗方法。方法 回顾性分析我院自2006年1月至2014年12月收治的39例椎管内脊膜囊肿（不包含骶管囊肿）患者的临床资料。结果 病变累及颈段3例,颈胸段1例,胸段11例,胸腰段18例,腰段5例,全椎管1例。本组35例行囊肿切除术,其中31例囊肿全切,4例囊壁大部切除;4例行囊肿-腹腔分流术。术中22例可见硬膜漏口并对漏口进行结扎或缝合外,或用自体脂肪或生物胶封闭。35例行囊肿切除术患者中,32例术后症状改善,3例无改善。4例行囊肿-腹腔分流术患者中,3例术后症状改善,1例无改善。术后随访3~6个月,影像学复查,囊肿均消失,均未见囊肿复发;39例患者术后Frankel 分级:C级6例,D级22例,E级11例;所有患者切口一期甲级愈合,无脑脊液漏,未有无菌性脑膜炎发生。结论 对于椎管内脊膜囊肿,MRI是首选的检查方法;手术是其有效方法;对于累及长节段脊髓的患者,开放手术难以全切时,可以考虑行囊肿-腹腔分流术以降低囊肿压力,缓解脊髓压迫。     

儿童颅内幕上蛛网膜囊肿的手术治疗

目的总结儿童颅内幕上蛛网膜囊肿手术治疗的经验。方法回顾性分析56例幕上蛛网膜囊肿病儿的临床资料,均经手术治疗,手术方法包括囊肿壁部分切除加囊肿脑池交通术30例,囊肿壁部分切除并囊肿脑池交通加颞肌条填入术20例,囊肿-腹腔分流术5例及神经内镜下囊肿壁部分切除并造瘘术1例。结果病儿术后临床症状均不同程度改善,颅内压增高症状术后均消失。术后高热(39℃)12例,并发颅内血肿4例,无手术死亡。随访3个月～5年,囊肿消失18例,缩小80%以上22例,缩小50%～80%8例,无明显变化6例;2例合并脑积水者,1例脑室较术前略缩小,另1例无变化。结论外科手术是儿童颅内幕上蛛网膜囊肿的有效治疗方法,术中仔细和轻柔操作是预防和减少相关手术并发症的关键。     

椎管内蛛网膜囊肿诊断及手术方式研究

目的探讨椎管内蛛网膜囊肿的诊断要点及手术方式。方法回顾性分析我院2001~2012年收治的9例椎管内蛛网膜囊肿病例,对其影像特点、病理特征、手术治疗进行总结。结果囊肿全切5例,囊肿次全切除加内引流4例。术后7例患者症状改善,2例无明显变化。随访3个月~11年,1例失访,4例复发。结论 MRI对术前诊断很重要。全椎板切除对囊肿暴露更好,半椎板切除脊柱稳定性更高。对粘连严重的囊肿不要求强行做全切除,次全切除并打通囊肿与脑脊液的交通即可。     

颅内蛛网膜囊肿的临床诊治（附22例报告）

目的探讨颅内蛛网膜囊肿的临床诊治。方法回顾分析手术治疗22例颅内蛛网膜囊肿患者临床资料,术式包括蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术及囊肿-腹腔分流术等。结果17例获得良好疗效,6例癫痫患者5例症状消失。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。     

Endoscopic treatment of convexity arachnoid cysts

Objective

The aim of this study was to investigate the endoscopic treatment of cerebral hemisphere convexity arachnoid cyst.

Methods

Eight cases of hemisphere convexity arachnoid cyst treated with cyst–ventricular or cisternal endoscopic approach in September 2007 to March 2011 were retrospectively recruited. The clinical symptoms, radiological findings, surgical indications, surgical approach, complications, and follow-up studies were analyzed.

Results

All patients showed convexity arachnoid cysts adjacent to the ventricles or cisternal. After treatment, all patients showed decrease in size of the cysts (100 %), with preoperative symptoms disappeared in six patients and improved in two cases. In one case, postoperative subdural effusion was found without symptoms reported.

Conclusion

Endoscopic surgery is ideal for treatment of arachnoid cysts adjacent to the ventricles or cisternal.     

儿童颞部蛛网膜囊肿的手术治疗

目的探讨儿童颞部蛛网膜囊肿的手术方法。方法回顾性分析手术治疗儿童颞部蛛网膜囊肿68例患者的临床资料,56例行显微镜下囊壁切除+脑池交通术,7例行囊肿-腹腔分流术,5例行内镜下囊壁切除+脑池交通术。结果术后随访6个月到3年,28例影像学复查显示:13例囊肿完全消失,46例囊肿体积较术前有不同程度缩小,无明显变化的有9例。结论显微镜下囊壁切除+脑池交通术对儿童颅内蛛网膜囊肿有着良好的治疗效果,可以作为首选的手术方式。     

颅内蛛网膜囊肿临床治疗分析

目的探讨颅内蛛网膜囊肿(IAC)的临床特征和治疗方法。方法IAC患者53例,其中47例行手术治疗,术式包括微创囊肿切除加局部的蛛网膜下腔及相关脑池开放术、蛛网膜囊肿部分切除术及囊肿-腹腔分流术等;6例未手术者临床随访观察。结果大部手术治疗者获得良好疗效,癫痫能得到控制或发作次数减少。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿部分切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。     

Assessment of endoscopic treatment for middle cranial fossa arachnoid cysts

Background

Endoscopic cystocisternotomy is one of three surgical methods used to treat middle cranial fossa arachnoid cysts. There is debate about which method is the best.

Objective

The aim of this study is to evaluate the effectiveness and safety of endoscopic cystocisternotomy for treatment of arachnoid cysts of the middle cranial fossa.

Methods

Thirty-two patients with arachnoid cysts of the middle cranial fossa who had undergone endoscopic cystocisternal fenestration between 2004 and 2009 were studied retrospectively. Data were obtained on clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and the results of clinical and neuroradiological follow-up.

Results

Among the 27 patients with symptoms before surgery, 8 had disappearance of symptoms and 17 had improvement of symptoms. The cyst was reduced in size or it completely disappeared in 24 (75%) patients. The incidence rate of complications was 18.8%.

Conclusions

Endoscopic cystocisternal fenestration is an effective treatment for symptomatic arachnoid cysts of the middle cranial fossa and should be the initial surgical procedure.     

Symptomatic supratentorial arachnoid cysts in children

This study was undertaken to evaluate the clinical and radiologic long-term outcome of symptomatic primary arachnoid cysts in pediatric patients. Thirty-three children, ranging from 2 months to 17 years of age (mean age, 6 years) were treated. Craniotomy and fenestration of the cyst were used for temporal fossa and midline cysts in 24 patients (73%); later, two patients required shunt placement. Shunting device implantation was performed for cerebral convexity cysts in nine patients (27%), and two patients required a subsequent craniotomy and fenestration of the cyst. Four patients (12%) required additional surgery because of clinical progression rather than for cyst enlargement. Eleven patients (33%) experienced a cyst reduction of more than 50% compared with the original size on imaging studies. There was a significant correlation with the alleviation of symptoms (P < 0.005), regardless of the treatment used. Complete alleviation of symptoms was achieved in all patients after treatment, regardless of cyst reduction. Long-term follow-up of 70 +/- 9.3 months demonstrated no recurrence of symptoms or progressive enlargement of the arachnoid cyst in all children.     

Endoscopic ventriculo-cystomy for non-communicating hydrocephalus secondary to quadrigeminal cistern arachnoid cyst

INTRODUCTION: Intracranial arachnoid cysts are developmental, anomalous collections of cerebrospinal fluid (CSF), and occasionally cause symptoms when large enough to obliterate the CSF outflow pathway and give rise to non-communicating hydrocephalus. The treatment of choice for symptomatic arachnoid cysts has been surgical excision or fenestration of the cyst, but less invasive endoscopic fenestration has been attempted with favorable preliminary results. CASE REPORT: We report a case of non-communicating hydrocephalus caused by a quadrigeminal cistern arachnoid cyst in a 35-year-old woman who presented with worsening headaches. She was successfully treated by endoscopic third ventriculostomy and fenestration of the cyst (ventriculo-cistomy). DISCUSSION: Endoscopic fenestration of symptomatic arachnoid cysts can be as effective as open surgery in terms of short-term efficacy, and it is certainly less invasive than open surgery. However, its long-term outcome remains unknown, and these rare cases require careful clinical and radiological follow-up.