CAJ | 학술논문

目的探讨神经内镜技术在小儿颅内囊液性疾病中的治疗应用,以及结合开颅术及分流术协同完成小儿颅内复杂畸形手术治疗的效果.方法 2004年2月至2009年2月,105例患儿接受内镜手术,年龄3个月至12岁.包括阻塞性脑积水53例,其中51例成功完成内镜下三脑室底造口术.脑内囊肿52例中有28例颞叶囊肿行镜下囊壁部分剥离术和脑池开放术,5例透明隔囊肿和5例侧脑室囊肿分别行囊肿-脑室造口术、3例鞍上及三脑室囊肿行囊肿剥离+三脑室底造口,幕下囊肿6例:其中内镜剥离1例,5例巨大囊肿合并脑积水者采取内镜结合分流或开颅显微镜下剥离术.幕上中线部位囊肿5例,囊肿部分剥离+开窗4例,1例多房打通结合囊肿腹腔分流术.结果 51例脑积水中,47例术后临床症状改善.52例颅内囊肿,术后随访2个月至3年,总体缩小率占98%,颞叶囊肿缩小率100%,11例术后有硬膜下积液,7例随访好转,4例术后4个月至1年出现慢性硬膜下血肿,行外引流术后治愈,1例合并中枢感染者放弃治疗.结论内镜手术在小儿颅内囊液性疾病的治疗中效果良好,可优先选择.
목적 탐토신경내경기술재소인로내낭액성질병중적치료응용,이급결합개로술급분류술협동완성소인로내복잡기형수술치료적효과.방법 2004년2월지2009년2월,105례환인접수내경수술,년령3개월지12세.포괄조새성뇌적수53례,기중51례성공완성내경하삼뇌실저조구술.뇌내낭종52례중유28례섭협낭종행경하낭벽부분박리술화뇌지개방술,5례투명격낭종화5례측뇌실낭종분별행낭종-뇌실조구술、3례안상급삼뇌실낭종행낭종박리+삼뇌실저조구,막하낭종6례:기중내경박리1례,5례거대낭종합병뇌적수자채취내경결합분류혹개로현미경하박리술.막상중선부위낭종5례,낭종부분박리+개창4례,1례다방타통결합낭종복강분류술.결과 51례뇌적수중,47례술후림상증상개선.52례로내낭종,술후수방2개월지3년,총체축소솔점98%,섭협낭종축소솔100%,11례술후유경막하적액,7례수방호전,4례술후4개월지1년출현만성경막하혈종,행외인류술후치유,1례합병중추감염자방기치료.결론 내경수술재소인로내낭액성질병적치료중효과량호,가우선선택.
Objective To explore the efficacy of intracranial neuroendoscopic procedures in the treatment of hydrocephalus or intracranial cysts in children.Methods Between February 2004 and February 2009,105 patients aged from 3 months to 12 years old,who were performed intracranial neuroendoscopic procedures were enrolled in this study.The 105 patients consisted of 53 patients with obstructive hydrocephalus and 52 with intracranial cysts.Fifty-one of the 53 hydrocephalus patientsunderwent endoscopic third ventriculostomy.On the 52 patients with intracranial cysts,different procedures were performed to remove the cysts and reconstruct the cerebrospinal fluid (CSF)circulation according to the locations of the cysts:endoscopic cyst part-resection and cystocisternostomy were performed for the 21 patients whose cysts were in temporal region;ventricle-cystostomy for the 5 patients with c ysts in septum and the 5 with cysts in paraventricular;septostomy for the 3 patients with suprasellar and third ventricle cysts;cyst part-resection and third ventriculostomy for the 6 with infratentorial cysts and the 5 with interhemispheric cysts.Results After surgery,47 cases with hydrocephalus had resolution or improvement of symptoms,the other 4 patients underwent ventriculoperitoneal shunt for postoperative CSF leakage.The 52 patients with intracranial cysts were followed up for 2months to 5 years.The reduction of cyst size was achieved on 98% patients.All temporal cysts' sizes disappeared after surgery.Subdural hygroma occurred in 11 cases,of which,7 were healed spontaneously,the other 4 developed chronic subdural hematoma and healed after external drainage.One patient with postoperative intracranial infection was given up on further treatments.Conclusions The intracranial neuroendoscopic surgery is effective to treat the hydrocephalus or intracranial cysts in children.