CAJ | 학술논문

目的探讨神经内镜治疗后颅窝囊肿合并脑积水的诊治方法。方法回顾性分析南方医院神经外科自2004年4月至2010年8月收治的31例后颅窝扩大囊室合并脑积水患者资料，所有患者均经头颅CT和MRI证实。其中后颅窝真性蛛网膜囊肿19例，Dandy walker畸形5例，布莱克囊肿2例，肿瘤术后囊肿5例。依据不同手术方式分成内镜手术组(14例)、开颅显微镜手术组（9例）和分流手术组（8例），根据术后患者临床症状改善情况、影像学表现和相关并发症发生情况判定疗效。结果 3组患者术后早期临床症状均有所改善。术后随访6个月～6年，复查头颅MRI显示28例患者后颅窝囊肿及脑室系统较术前有不同程度的缩小，其中内镜组有效率和并发症发生率分别为92.9％和14.3％,显微镜组分别为88.9％和33.3％，分流手术组分别为75.0％和50.0％。结论神经内镜是治疗后颅窝囊肿合并脑积水的一种安全、有效术式，相对显微镜下开颅手术和分流手术而言，操作灵活，并发症少，预后好，值得临床进一步推广。
목적 탐토신경내경치료후로와낭종합병뇌적수적진치방법。 방법 회고성분석남방의원신경외과자2004년4월지2010년8월수치적31례후로와확대낭실합병뇌적수환자자료，소유환자균경두로CT화MRI증실。기중후로와진성주망막낭종19례，Dandy walker기형5례，포래극낭종2례，종류술후낭종5례。의거불동수술방식분성내경수술조(14례)、개로현미경수술조（9례）화분류수술조（8례），근거술후환자림상증상개선정황、영상학표현화상관병발증발생정황판정료효。 결과 3조환자술후조기림상증상균유소개선。술후수방6개월～6년，복사두로MRI현시28례환자후로와낭종급뇌실계통교술전유불동정도적축소，기중내경조유효솔화병발증발생솔분별위92.9％화14.3％,현미경조분별위88.9％화33.3％，분류수술조분별위75.0％화50.0％。 결론 신경내경시치료후로와낭종합병뇌적수적일충안전、유효술식，상대현미경하개로수술화분류수술이언，조작령활，병발증소，예후호，치득림상진일보추엄。
Objective To explore the process and technique ofneuroendoscopic operation in obstructive hydrocephalus caused by cysts of the posterior fossa. Methods An analysis of 31 patients with obstractive hydrocephalus caused by cysts of the posterior fossa, admitted to our hospital from April 2004 to August 2010, was performed; CT and MRI were performed on these patients. Among all the 31patients, 19 had arachnoid cyst of the posterior fossa, 5 Dandy-Walker malformations, 2 Blake' s pouch cyst, and 5 cysts after resection of the tumor. Treatment efficacy was determined according to the improvement of clinical symptoms, imaging manifestations and appearing of relative complications.Results Endoscopic management (n=14), microsurgery (n=9) and ventriculoperitoneal shunt (n=8) were performed. All the patients' postoperative hydrocephalus was alleviated in early stage of treatnent.Subsequent follow-up, ranged from 0.6 to 6 years, revealed a sharp reduction of sizes of the cyst and ventricle system under MRI in 28 patients, with a total effective rate of 87.1％. The effective rate and incidence of complications were 92.9％ and 14.3％ in patients performed endoscopic management, 88.9％and 33.3％ in patients performed microsurgery, and 75％ and 50％ in patients performed ventriculoperitoneal shunt, respectively.Conclusion Neuroendoscopic procedure is a safe and effective technique for hydrocephalus caused by cysts of the posterior fossa; as compared with those with microsurgery and ventriculoperitoneal shunt, higher success rate and less operative complications are achieved in patients with endoscopic management.