Meng Hui, Feng Hua, Le Fei, Lu Jia Y
Department of Neurosurgery, Southwest Hospital, Third Military Medical University, ShaPingBa, Chongqing, China.
Neurosurgery. 2006 Aug;59(2):278-83; discussion 278-83. doi: 10.1227/01.NEU.0000223770.65379.21.
Ten rare cases of symptomatic septum pellucidum cysts in patients who underwent endoscopic fenestration are described. The approaches and techniques used in the management of these cysts and the endoscopic surgical indications are discussed.
In the past 5 years, 10 patients (age range, 3-60 yr) with symptomatic septum pellucidum cysts underwent neuroendoscopic fenestration. The most common symptom was intermittent headache (seven patients) accompanied by dizziness, vomiting, and epileptic seizures. Two patients presented with epileptic seizures. One patient presented with abnormally increased head circumference. Magnetic resonance imaging scans of 10 patients showed septum pellucidum cysts, two with hydrocephalus, and two with pituitary microadenoma.
All 10 patients underwent endoscopic fenestration with a rigid endoscope via a frontal approach. Eight cases were performed freehand. Two cases were assisted by a frameless neuronavigation system. Postoperatively, the mass effect of the cysts and the symptoms resolved immediately, and computed tomographic or magnetic resonance imaging scans showed significant decrease in the cyst size and no recurrence during follow-up. Ventricular sizes in the two patients with hydrocephalus were normal.
Neuroendoscopic pellucidotomy could be an effective, safe, and convenient therapeutic method for symptomatic septum pellucidum cysts. This approach might provide communication between the cyst and the ventricular system, thus avoiding shunting or craniotomy. We consider that it is appropriate to use the rigid endoscope via the frontal approach. It is helpful to fill the ventricles with lactated Ringer's solution and leave an external drain after surgery.
描述10例接受内镜开窗术的有症状透明隔囊肿患者的罕见病例。讨论了这些囊肿治疗中使用的方法和技术以及内镜手术指征。
在过去5年中，10例有症状透明隔囊肿患者（年龄范围3 - 60岁）接受了神经内镜开窗术。最常见的症状是间歇性头痛（7例患者），伴有头晕、呕吐和癫痫发作。2例患者表现为癫痫发作。1例患者表现为头围异常增大。10例患者的磁共振成像扫描显示透明隔囊肿，2例伴有脑积水，2例伴有垂体微腺瘤。
所有10例患者均通过额部入路使用硬质内镜进行内镜开窗术。8例徒手操作。2例在无框架神经导航系统辅助下进行。术后，囊肿的占位效应和症状立即缓解，计算机断层扫描或磁共振成像扫描显示囊肿大小显著减小，随访期间无复发。2例脑积水患者的脑室大小正常。
神经内镜透明隔造瘘术可能是治疗有症状透明隔囊肿的一种有效、安全且便捷的方法。这种方法可能使囊肿与脑室系统相通，从而避免分流或开颅手术。我们认为经额部入路使用硬质内镜是合适的。术后用乳酸林格氏液充盈脑室并留置外引流管是有帮助的。
