蛛网膜囊肿合并慢性硬膜下血肿的外科治疗

Surgical Treatment of an Arachnoid Cyst Complicated with a Chronic Subdural Hematoma

摘要: 目的：探讨蛛网膜囊肿合并慢性硬膜下血肿的临床特点与外科治疗方法。方法：回顾分析苏州大学附属第一医院神经外科及伊犁医院自2021年1月至2024年3月收治蛛网膜囊肿合并慢性硬膜下血肿患者3例，其中1例患者行开颅囊肿剥除 + 硬膜下血肿清除术，另1例患者行神经内镜下囊肿切除 + 硬膜下血肿清除术，最后1例患者行单侧硬膜下血肿钻孔引流术。回顾性分析患者的临床资料和疗效，并且结合文献(对PubMed、Embase、Cochrane Library、Medline、中国知网、万方、维普等数据库进行系统的文献检索)进行总结。结果：选择硬膜下血肿钻孔引流术与神经内镜下囊肿切除 + 硬膜下血肿清除术的两例患者为儿童，术后随访2年，蛛网膜囊肿与血肿均无复发；1例行开颅囊肿剥除 + 硬膜下血肿清除术患者为青年男性，术后复查CT存在少量硬膜外血肿，经引流后，患者术后恢复良好。通过文献复习蛛网膜囊肿合并慢性硬膜下血肿的病人，总结其临床特征及外科治疗方法。IAC合并CSDH少见，通常发生于青年人，常发生于囊肿的同侧，外伤、剧烈运动是发生慢性硬膜下血肿的主要诱因；蛛网膜囊肿合并慢性硬膜下血肿患者的治疗一般选择钻孔引流术；对于囊肿或者血肿复发的患者，无需急于再次钻孔或者急于行针对囊肿的手术，可随访观察；对于出血前囊肿就有症状或者囊肿反复出血的患者，可以在血肿清除同时切除囊肿。结论：蛛网膜囊肿合并慢性硬膜下血肿患者的外科治疗包括钻孔引流术、神经内镜下囊肿切除 + 硬膜下血肿清除、显微镜下囊肿切除 + 硬膜下血肿清除，可以取得较好的手术疗效。

Abstract: Objective: To investigate the clinical characteristics and surgical treatment of arachnoid cyst combined with chronic subdural hematoma. Methods: Review analysis of the first affiliated hospital of Suzhou university neurosurgery and Yili hospital from January 2021 to March 2024 treated arachnoid cyst with chronic subdural hematoma 3 patients, including one patient with craniotomy cyst removal + subdural hematoma removal, another patient with nerve endoscopic cyst removal + subdural hematoma removal, the last one patient with unilateral subdural hematoma drilling drainage. The clinical data and efficacy of patients were retrospectively analyzed, and the literature (systematic literature search of PubMed, Embase, Cochrane Library, Medline, CNKI, CNER, Wanfang, VIP and other databases was conducted) was summarized. Results: Two patients with drilling and drainage of subdural hematoma and neuroendoscopic cyst removal + subdural hematoma removal were selected as children, with no arachnoid cyst or hematoma recurrence; The patient was a young man, and the patient recovered well after drainage. Patients with arachnoid cysts combined with chronic subdural hematoma were reviewed through the literature, and their clinical characteristics and surgical treatment methods were summarized. IAC with CSDH is rare, usually occurs in young people, often occurring in the same side of the cyst, trauma and strenuous exercise are the main cause of chronic subdural hematoma; arachnoid cyst patients with chronic subdural hematoma generally choose drilling drainage; for patients with cyst or hematoma recurrence, there is no need to drill again or cyst surgery, follow-up observation; for patients with the cyst symptoms or repeated bleeding before bleeding, the cyst can be removed from the hematoma at the same time. Conclusion: The surgical treatment of patients with arachnoid cyst combined with chronic subdural hematoma includes drilling and drainage, neuroendoscopic cyst removal and subdural hematoma removal, microscopic cyst removal and subdural hematoma removal, which can achieve good surgical effect.