儿童颅内蛛网膜囊肿手术治疗方法的不同术式对比研究
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摘要
目的：
探讨儿童颅内蛛网膜囊肿的最佳术式以规范手术治疗。
方法：
应用随访研究的方法比较三种不同术式治疗儿童颅内蛛网膜囊肿89例的效果，通过对术后3、6、12个月的全部病例进行随访，对三种不同术式的临床总体疗效进行评价。资料采用SPSS11.0统计软件包处理。
结果：
选择三种不同术式共治疗儿童颅内蛛网膜囊肿89例，其中囊肿切除术(A组)27例，显微镜下囊肿切除并脑池交通术(B组)41例，囊肿一腹腔分流术(C组)21例。不同手术治疗组病人术后临床症状改善率与囊肿消失和缩小率均随时间延长而增加，3、6、12个月随访时上述两项指标均以B组最高，其中6个月随访时，临床症状改善率分别为51.9％、80.5％、71.4％，囊肿消失和缩小率为48.1％、82.9％、71.4％；12个月随访时，A、B、C三组二项指标各自为63.0％、92.7％、90.5％和55.6％、87.8％、85.7％。6个月、12个月时三组间上述两项指标比较均有显著性差异(P＜0.05)；癫痫控制率：开颅手术(A、B两组)均为50.0％，高于分流术组(C组)(25.0％)；在术后复发的对比分析中发现，术后3个月随访时各组无囊肿复发，6、12个月随访时，B组的复发率较低，与A组比较尤其明显，但三组间差异尚无统计学意义(P＞0.05)；术后并发症的总发生率为24.7％，三组各自的并发症发生率接近，差异无统计学意义。综合术后临床总体疗效的各项指标对比分析结果显示：三种治疗方法都是安全有效的，其中B组治疗术式即显微镜下囊肿切除并脑池交通术效果最佳。
结论：
显微镜下囊肿切除并脑池交通术可能为治疗儿童颅内蛛网膜囊肿的最佳术式，可作为首选治疗方法。术中强调规范化操作，可减少术后并发症的发生。
Objective
To explore the best operation method in order to standardize thesurgical treatment for intracranial arachnoid cyst in children.
Methods
Follow-up investigation methods were used to study the results ofthree different operation methods for treating intracranial arachnoid cystin children, especially to contrast and analyze various quotas based on 89cases follow-up data(3rd、6th、12th month after operation)which couldevaluate correctly clinical general curative effect. Statistical analyseswere perfomed by SPSS11.0.
Results
Three different operation methods were adopted to treat 89 patientswith intracranial arachnoid cyst, in which cyst removal was performed in27cases(group A), cyst removal plus citemal opening throughmicrosurgical techniques in 41 cases(group B),and cystoperitoneal shuntin 21 cases (group C). All subjects were followed up at 3rd、6th、12th month. The rates of both improvement of chief clinical symptoms andcysts disappearance and shrinkage increased by the time after operation,up to 6th month after operation, the above-mentioned two quotas of groupA、B、C were 51.9%,80.5% and 71.4% and 48.1%, 82.9% and 71.4%,respectively; up to 12th month, it was 63.0%, 92.7% and 90.5%; 55.6%,87.8% and 85.7% respectively, of three groups, group B had the highestrates among three groups with significant statistical difference (p＜0.05).At 12th month after operation, more patients with intracranial arachnoidcyst accompanied epilepsy became seizure-free or had less seizure attackin craniotomy (group A and group B,50.0%)than in cystopentoneal shunt(group C, 25.0%)but there was no significant difference among threegroups. No recurrence of cysts was found at 3rd month after operation,until 6th、12th month, there was recurrence of cysts in every group, ofthem, the recurrence rate of group B was lower, especially compared withthat of group A, but similarly no significant difference exsited amongthree groups. In addition, the incidence rate of post-operationcomplications in 3 groups showed no significant difference(P＞0.05). Ina word, comparison of clinical general curative effect among allgroups(A、B、C)showed that microsurgical cyst removal plus cisternalopening to treat intracranial arachnoid cyst in children was the bestmethods of operation.
Conclusions
The surgical treatment for intracranial arachnoid cyst in childrenthrough microsurgical cyst removal plus cistemal opening might be thebest method of operation and could be chosen first. Besdes, standardizedoperation sequences must be emphasized in order to reduce probability ofappearance of post-operation complications.
探讨儿童颅内蛛网膜囊肿的最佳术式以规范手术治疗。
方法：
应用随访研究的方法比较三种不同术式治疗儿童颅内蛛网膜囊肿89例的效果，通过对术后3、6、12个月的全部病例进行随访，对三种不同术式的临床总体疗效进行评价。资料采用SPSS11.0统计软件包处理。
结果：
选择三种不同术式共治疗儿童颅内蛛网膜囊肿89例，其中囊肿切除术(A组)27例，显微镜下囊肿切除并脑池交通术(B组)41例，囊肿一腹腔分流术(C组)21例。不同手术治疗组病人术后临床症状改善率与囊肿消失和缩小率均随时间延长而增加，3、6、12个月随访时上述两项指标均以B组最高，其中6个月随访时，临床症状改善率分别为51.9％、80.5％、71.4％，囊肿消失和缩小率为48.1％、82.9％、71.4％；12个月随访时，A、B、C三组二项指标各自为63.0％、92.7％、90.5％和55.6％、87.8％、85.7％。6个月、12个月时三组间上述两项指标比较均有显著性差异(P＜0.05)；癫痫控制率：开颅手术(A、B两组)均为50.0％，高于分流术组(C组)(25.0％)；在术后复发的对比分析中发现，术后3个月随访时各组无囊肿复发，6、12个月随访时，B组的复发率较低，与A组比较尤其明显，但三组间差异尚无统计学意义(P＞0.05)；术后并发症的总发生率为24.7％，三组各自的并发症发生率接近，差异无统计学意义。综合术后临床总体疗效的各项指标对比分析结果显示：三种治疗方法都是安全有效的，其中B组治疗术式即显微镜下囊肿切除并脑池交通术效果最佳。
结论：
显微镜下囊肿切除并脑池交通术可能为治疗儿童颅内蛛网膜囊肿的最佳术式，可作为首选治疗方法。术中强调规范化操作，可减少术后并发症的发生。
Objective
To explore the best operation method in order to standardize thesurgical treatment for intracranial arachnoid cyst in children.
Methods
Follow-up investigation methods were used to study the results ofthree different operation methods for treating intracranial arachnoid cystin children, especially to contrast and analyze various quotas based on 89cases follow-up data(3rd、6th、12th month after operation)which couldevaluate correctly clinical general curative effect. Statistical analyseswere perfomed by SPSS11.0.
Results
Three different operation methods were adopted to treat 89 patientswith intracranial arachnoid cyst, in which cyst removal was performed in27cases(group A), cyst removal plus citemal opening throughmicrosurgical techniques in 41 cases(group B),and cystoperitoneal shuntin 21 cases (group C). All subjects were followed up at 3rd、6th、12th month. The rates of both improvement of chief clinical symptoms andcysts disappearance and shrinkage increased by the time after operation,up to 6th month after operation, the above-mentioned two quotas of groupA、B、C were 51.9%,80.5% and 71.4% and 48.1%, 82.9% and 71.4%,respectively; up to 12th month, it was 63.0%, 92.7% and 90.5%; 55.6%,87.8% and 85.7% respectively, of three groups, group B had the highestrates among three groups with significant statistical difference (p＜0.05).At 12th month after operation, more patients with intracranial arachnoidcyst accompanied epilepsy became seizure-free or had less seizure attackin craniotomy (group A and group B,50.0%)than in cystopentoneal shunt(group C, 25.0%)but there was no significant difference among threegroups. No recurrence of cysts was found at 3rd month after operation,until 6th、12th month, there was recurrence of cysts in every group, ofthem, the recurrence rate of group B was lower, especially compared withthat of group A, but similarly no significant difference exsited amongthree groups. In addition, the incidence rate of post-operationcomplications in 3 groups showed no significant difference(P＞0.05). Ina word, comparison of clinical general curative effect among allgroups(A、B、C)showed that microsurgical cyst removal plus cisternalopening to treat intracranial arachnoid cyst in children was the bestmethods of operation.
Conclusions
The surgical treatment for intracranial arachnoid cyst in childrenthrough microsurgical cyst removal plus cistemal opening might be thebest method of operation and could be chosen first. Besdes, standardizedoperation sequences must be emphasized in order to reduce probability ofappearance of post-operation complications.
引文
[1] 孙青芳，沈健康，丁美修．颅内蛛网膜囊肿．国外医学神经病学神经外科学分册，1998，25：17-21．
[2] Murali R, Epstein F. Diagnosis and treatment of suprasellar arachnoid cyst. J Neurosurg, 1979, 50: 515.
[3] Dei—Anang K, Voth D. Cerebral arachnoid cyst:a lesion of the child's brain. Neurosurg. Rev, 1989,12: 59.
[4] Galassi E, Piazza G, Gaist G, et al. Arachnoid cysts of the middle cranial fossa:a clinical and radiological study of 25 cases treated surgically. Surg Neurol, 1980,14: 211.
[5] Barra R, Kessva PP. Role of MRI in the diagnosis of complicated arachnoid cyst. Pediatr Radiol.2000, 30: 329—331.
[6] Gonzalez CA, Villarejo FJ, Blazquez MG, et al. Suprasellar arachnoid cysts in children:report of three cases. Acta Neurochir,1982,60:281.
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[1] 孙青芳，沈健康，丁美修。颅内蛛网膜囊肿。国外医学神经病学神经外科学分册，1998，25：17-21．
[2] 吴茂春，罗世祺。神经上皮囊肿。中华神经外科杂志，2006，22：515-516．
[3] Arai H, sato K, Wachi A, et al. Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cysto peritoneal shunting. Neurosurgery, 1996,39(6):1108-1113.
[4] 包长顺，夏佐中．小儿颅内蛛网膜囊肿的外科处理．中华小儿外科杂志，2003，24：369-370．
[5] Wester K. Peculiarities of intracranial arachnoid cysts: location, side ness, and sex distribution in 126 consecutive patients. Neurosurgery, 1999,45:778.
[6] 孙莲萍，金惠明，施诚仁．微创手术方法治疗小儿颅内蛛网膜囊肿49例报告．中国神经精神疾病杂志，2004，30：136-137．
[7] Murali R, Epstein F. Diagnosis and treatment of suprasellar arachnoid cyst. J Neurosurgery, 1979,50:515.
[8] Galassi E, Piazza G, Gaist G, et al. Arachnoid cyst of the middle cranial fossa:a clinical and radiological study of 25 cases treated surgically. Surg Neurol, 1980,14:211.
[9] Go KG, Houth off Hi, Blaauw EH, et al. Arachnoid cysts of the sylvian fissure. J Neurosurg, 1984,60:803.
[10] Becker T, Wagner M, Hofmann E, et al. Do arachnoid cysts grow? a retrospective CT Volumetric study. Neuroradiology, 1991,33:341.
[11] Kjos BO, Brant-zawadzki M, Kucharczyk W, et al. Cystic intracranial lesion: magnetic resonance imaging. Radiology, 1985,155:363.
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[14] 楚功仁，史锡文，陈航，等．巨大枕大池25例分析．中华神经外科杂志，1999，15：178-180．
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[17] Mori T, Fujimoto M, Sakae k, et al. Disappearance of arachnid cysts after head injury. Neurosurgery, 1995,36(5):938-942.
[18] Vcar T, Akyuz M, Kazan S, et al. Bilateral cerebellopontine angle arachnoid cysts: case report. Neurosurgery, 2000,47:966-968.
[19] Artico M, Gervoni, Sauati M, et al. Supratentorial arachnoid cysts: clinical and therapeutic remarks on 46 cases, Acta Neurotic, 1995,132:75-80.
[20] Cilicillo SF, Cogen PH, Harsh GR, et al. intracranial arachnid cysts in children. J Neurosurg, 1991,74:230-236.
[21] Yamauchi T, Saeki N, Yamaaura h, Spontancous disappearance of tempore frontal arachnoid cyst in a child, Acta Neurotic(Wren),1999, 141:537-540.
[22] Sgouros S, Chapman S. Congenital middle fossa arachnoid, cysts may cause global brain ischaemia. Pediatr Neurosurgery, 2001,35(4):188.
[23] 杨利孙，章翔，费舟，等．儿童颅内蛛网膜囊肿的手术探讨．中华小儿外科杂志，2001，22：163-165．
[24] Soukup VM, Patterson J, Trier TT, et al. Cognitive improvement despite minimal arachnoid cyst decompression. Brain Dev, 1998, 20:589-593.
[25] Kang JK, Lee TW, Jeun SS, et al. Shunt in dependent surgical treatment of middle cranial fossa arachnoid cysts in children. Childs Nerv Syst, 2000,16:111-116.
[26] Lena G, Erdincler P, Van C, et al. Arachnoid cysts of the middle cranial fossa in children, a review of 75 cases, 47 of which have been operated in a comparative study between membranectomy with opening of cisterns and cystoperitoneal shunt. Neurochirurgie, 1996,42:29-34.
[27] Shigemori M, Okura A, Takahashi Y, et al. New surgical treatment of middld fossa arachnoid cyst. Surg Neurol, 1996,45:189-192.
[28] Samii M, Carvalho GA, SchuhmannMU, et al. Arachnoid cysts of the posterior fossa. Surg Neurol, 1999,51:376-382.
[29] 周大彪，赵继宗．桥小脑角蛛网膜囊肿(附17例报告)．中华神经外科杂志，2002，18：181-182．
[30] 彭玉平，张喜安，漆松涛，等．神经内镜手术治疗颅内蛛网膜囊肿，中华神经医学杂志，2005，4：585-588．
[31] 孙康健，谭启富，孙克华．儿童蛛网膜囊肿伴癫痫的外科治疗．中国神经精神疾病杂志，2001，27：186-188．
[32] 温振东，郭立通．儿童颅内蛛网膜肿的治疗．中华神经医学杂志，2006，5：296-297．
[33] 王忠诚．二十一世纪的神经外科学—微创神经外科学．中华神经外科杂志，2001，17：1-3．
[34] 陈乾，付桂兵，赵瑞珍，等．囊肿—腹腔分流术治疗不同类型的儿童颅内蛛网膜囊肿．中华神经医学杂志，2006，5：536-537．
[35] 刘丕楠，王忠诚，张亚卓，等．内镜下手术诊疗颅内囊性病变．中华神经外科杂志，2001，17：211-213．
[36] Godano U, Mascari C, Consales A, et al. Endoscope-controlled microneurosurgery for the treatment of intracranial fluid cysts. Childs Nerv Syst, 2004,20:839-841.
[37] Levy ML, Wang M, Aryan HE, et al. Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. [J] Neurosurgery, 2003, 53:1138-1145.
[38] Mc Bride LA, Winston KR, Freeman JE. Cystoventricular shunting of intracranial arachnoid cysts. Pediatr Neurosurg, 2003,39:32.3-329.
[39] Yoshie N, Katsu M, Kazuki Y, et al. Endoscopic treatment for a huge neoonatal prepontine—suprasellar arachnoid cyst: A case report. Pediatr Neurosurg, 2001,35:220-224.
[40] 刘峥，蔡智基，黄绳跃，等．颅内蛛内膜囊肿开颅术后并发症的分析．中华神经外科杂志，2002，18：190-192．
[2] Murali R, Epstein F. Diagnosis and treatment of suprasellar arachnoid cyst. J Neurosurg, 1979, 50: 515.
[3] Dei—Anang K, Voth D. Cerebral arachnoid cyst:a lesion of the child's brain. Neurosurg. Rev, 1989,12: 59.
[4] Galassi E, Piazza G, Gaist G, et al. Arachnoid cysts of the middle cranial fossa:a clinical and radiological study of 25 cases treated surgically. Surg Neurol, 1980,14: 211.
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