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。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 202
慢性硬膜下血肿(chronic subdural hematoma, cSDH)是常见的神经外科疾病,多见于老年人。血肿的进展原因、转化为慢性的过程有其复杂的病理生理机制,并与治疗效果息息相关。目前,慢性硬膜下血肿的主要治疗方法是钻孔引流术,但存在需要再次手术的复发风险,目前术后复发率约9%~37%。目前所认为的血肿复发的主要原因主要是钻孔术后血肿包膜依旧存在,血肿形成的病理生理机制并未被阻断。为降低术后复发率,目前对潜在病理生理学机制的理解已用于新的治疗方法——脑膜中动脉栓塞术(middle meningeal artery embolization, MMAE)。还需要大量研究以确定脑膜中动脉栓塞术是否能成功停止血肿进展过程,从而控制和缓解cSDH。本文就cSDH发生发展过程中的血管生成、炎症反应、纤溶亢进等关键过程以及cSDH复发机制和降低复发率的手术方式进行综述。Chronic subdural hematoma (cSDH) is a common neurosurgical disease, mostly seen in the elderly. The progressive, chronic course of the disease has its own complex pathophysiological mechanisms and is closely related to the outcome of treatment. Currently, the main treatment for chronic subdural hematomas is drilling and drainage, but there is a risk of recurrence requiring reoperation, with current recurrence rates of approximately 9%~37%. The main reason for hematoma recurrence is that the hematoma envelope remains after drilling, and the pathophysiological mechanism of hematoma formation has not been blocked. To reduce the rate of postoperative recurrence, an understanding of the underlying pathophysiological mechanisms has been used in a new therapeutic approach, middle meningeal artery embolization (MMAE). Numerous studies are needed to determine whether MMAE is successful in stopping the process of hematoma generation and thus controlling and alleviating cSDH. This article provides a review of the key processes of angiogenesis, inflammatory response, and hyper
