Gangemi M, Maiuri F, Colella G, Sardo L
Department of Neurosurgery, School of Medicine, University Federico II, Naples, Italy.
Minim Invasive Neurosurg. 2001 Mar;44(1):21-4. doi: 10.1055/s-2001-13588.
The authors report two cases of large arachnoid cysts of the posterior fossa treated by endoscopic surgery. One patient underwent a successful endoscopic cyst fenestration by burr hole approach after several procedures of shunt revision. In another an endoscope-assisted microsurgical intervention was necessary. Lateral (cerebellar or cerebellopontine angle) cysts, as two reported cases, may be treated through a lateral retromastoid approach by fenestration into the prepontine cistern and eventually into the cisterna magna. We advise to start the operation through a burr hole and to try to realize the fenestration by endoscopy only. If this attempt fails, an endoscope-assisted microsurgical technique may be performed by enlarging the craniectomy. In this last instance the endoscope is useful particularly deeply to fenestrate the anterior cyst wall in the prepontine or ambient cisterns, where it provides more illumination and helps to identify the nervous and vascular structures.
作者报告了两例采用内镜手术治疗的后颅窝大型蛛网膜囊肿病例。一名患者在多次分流修复手术后，通过钻孔入路成功进行了内镜下囊肿开窗术。另一名患者则需要进行内镜辅助显微手术干预。如两例报告病例所示，外侧（小脑或小脑脑桥角）囊肿可通过外侧乳突后入路，开窗进入脑桥前池并最终进入枕大池进行治疗。我们建议先通过钻孔开始手术，并尝试仅通过内镜实现开窗。如果此尝试失败，可通过扩大颅骨切除术进行内镜辅助显微手术技术。在最后这种情况下，内镜特别有助于在脑桥前池或环池深处开窗囊肿前壁，在此处它提供更多照明并有助于识别神经和血管结构。
