CAJ | 학술논문

目的探讨囊肿脑池造瘘术治疗儿童中颅窝蛛网膜囊肿(intracranial arachnoid cyst,IAC)的效果及MRI相位对比电影(phase-contrast cine,PC cine)用于囊肿分型诊断及术后疗效评估的价值.方法对28例中颅窝IAC患儿行PC cine检查,选择非交通性蛛网膜囊肿(non-communicating intracranial arachnoid cysts,NCIAC)的患儿,行显微镜下囊肿脑池造瘘术.回顾分析术前术后临床表现、术后随访囊肿的缩小情况及PC cine MRI资料,定性评估造瘘口脑脊液流动,测量脑脊液动力学指标(峰值流速、流量及流动波型).结果 28例患儿中有20例行PC cine MRI检查诊断为NCIAC,行囊肿与鞍上池造瘘术.20例患儿术后随访囊肿呈进行性缩小,临床症状均有不同程度缓解.术后20例患儿造瘘口脑脊液流动均为阳性:在一个心动周期内表现为双向运动,与正常导水管流动波形相似,提示造瘘口通畅.28例患儿中有8例PC cine MRI诊断为CIAC,均无临床症状,未手术,经3个月至1年随访囊肿无进行性增大.结论 ①囊肿脑池造瘘是治疗儿童中颅窝IAC的有效方法,其近期疗效较为肯定;②PC cine MRI可以作为诊断非交通性IAC和评价IAC脑池造瘘术疗效的有效方法.
목적 탐토낭종뇌지조루술치료인동중로와주망막낭종(intracranial arachnoid cyst,IAC)적효과급MRI상위대비전영(phase-contrast cine,PC cine)용우낭종분형진단급술후료효평고적개치.방법 대28례중로와IAC환인행PC cine검사,선택비교통성주망막낭종(non-communicating intracranial arachnoid cysts,NCIAC)적환인,행현미경하낭종뇌지조루술.회고분석술전술후림상표현、술후수방낭종적축소정황급PC cine MRI자료,정성평고조루구뇌척액류동,측량뇌척액동역학지표(봉치류속、류량급류동파형).결과 28례환인중유20례행PC cine MRI검사진단위NCIAC,행낭종여안상지조루술.20례환인술후수방낭종정진행성축소,림상증상균유불동정도완해.술후20례환인조루구뇌척액류동균위양성:재일개심동주기내표현위쌍향운동,여정상도수관류동파형상사,제시조루구통창.28례환인중유8례PC cine MRI진단위CIAC,균무림상증상,미수술,경3개월지1년수방낭종무진행성증대.결론 ①낭종뇌지조루시치료인동중로와IAC적유효방법,기근기료효교위긍정;②PC cine MRI가이작위진단비교통성IAC화평개IAC뇌지조루술료효적유효방법.
Objective To evaluate the curative effect of cystocistern fenestration for the treatment of middle cranial fossa cyst in children and the value of post-operative evaluation using phase-contrast MRI.(PC-MRI).Methods 28 patients with intracranial arachnoid cysts (IAC) underwent PC-MRI assessment.Cystocistern fenestration was decided in those who were found to have NCIAC.A retrospective study was carried out analysing the clinical manifestations before and after surgery,postoperative decrease of the cyst size using phase-contrast cine MRI scan in these cases.The fistula flow of cerebrospinal fluid,the cerebrospinal fluid dynamics index (peak velocity,flow and flow wave) were obtained.Results Phase-contrast cine MR imaging showed no communication between IAC and the adjacent subarachnoid space in 20 of 28 patients pre-operation and they underwent cystocistern fenes tration.In these patients,arachnoid cysts reduced in size post-operatively.Furthermore,the clinical symptoms were improved or cured.CSF flow direction in the fistula of the basal cistern were bi-directional,which was similar to normal aqueduct flow waveform,suggesting patent fistula.In the 8 patients who were diagnosed to have communicating arachnoid cyst (CIAC),there was no clinical manifestation and no progressive increase in cyst size.Conclusions 1.Cystocistern fenestration could be an effective treatment of children with middle cranial fossa cysts; 2.PC cine MRI can be used to diagnose and assess post-operative progress of non-communicating IAC.