Chin J Schisto Control ›› 2019, Vol. 31 ›› Issue (5): 529-.

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Clinical features and efficacy of microsurgery for treatment of cerebral cysticercosis of the fourth ventricle: a report of 24 patients

ZHANG Zheng-Ping1, XU Chang-Lin1, XI Chao-Jie1, ZHANG Xiao-Lu2*   

  1. 1 Department of Neurosurgery, Affiliated Hospital of Qinghai University, Xining 810001, China; 2 Department of Neurosurgery,Wuxi People’s Hospital Affiliated to Nanjing Medical University, China
  • Online:2019-11-04 Published:2019-11-05

24例第四脑室囊尾蚴病患者临床特征及显微手术治疗效果

张正平1,许常林1,葸超杰1,张晓路2*   

  1. 1 青海大学附属医院神经外科(青海 810001);2 南京医科大学附属无锡市人民医院神经外科
  • 作者简介:张正平,男,本科,副主任医师。研究方向:颅底显微神经外科

Abstract: Objective To analyze the clinical characteristics of 24 patients with cysticercosis of the fourth ventricle, and to evaluate the therapeutic efficacy of microsurgery. Methods The clinical data of 24 patients with cysticercosis of the fourth ventricle referred the Department of Neurosurgery of the Affiliated Hospital of Qinghai University from January 2000 to December 2018 were collected, and the clinical features, imaging characteristics, surgical methods, therapeutic efficacy and postoperative complications were analyzed. Results The 24 patients included 15 men and 9 women, and had a mean age of 43.5 years (range, 16 to 68 years). Preoperative imaging examinations showed obvious dilatation of bilateral lateral ventricles, the third ventricle and middle cerebral aqueduct, and spherical or cystic dilatation of the fourth ventricle. There were 18 cases positive for antibodies against cysticercus, and 3 of the 21 cases were egg positives. All 24 cases received microsurgery, including 8 cases via the median aperture approach, 7 cases via the median aperture?cerebellar vermis approach, and 9 cases via the transcerebellomedullary fissure approach. There were 17 cases with complete delivery of vesicles, 5 cases with vesicle rupture and 2 cases with extraction of cystic fluid followed by separation and removal of cystic wall. All cases had obvious retraction of the ventricular system and disappearance of intracranial hypertension following surgery. There were 19 cases (79.17%) with well recovery, and 5 cases (20.83%) with aggravation or development of cerebellar ataxia, which recovered following treatment for 1 to 2 weeks. Conclusion The transcerebellomedullary fissure approach is a safe and lowly invasive approach for the treatment of cysticercosis of the fourth ventricle.

Key words: Cerebral cysticercosis, Fourth ventricle, Clinical feature, Microsurgery, Therapeutic effect

摘要: 目的 分析24例第四脑室囊尾蚴病患者临床特征,评估显微手术治疗效果。方法 收集2000年1月至2018年12月青海大学附属医院神经外科收治的24例第四脑室囊尾蚴病患者临床资料,对其临床特征、影像学表现、手术入路方式及效果、术后并发症等进行分析。结果 24例第四脑室囊尾蚴病患者中,男性15例,女性9例;年龄16~68岁,平均43.5岁。术前CT及MRI检查示患者双侧侧脑室、三脑室、中脑导水管明显扩张,第四脑室球形或囊形扩张。18例患者抗囊尾蚴抗体阳性;21例行粪便检查,其中3例检出虫卵。24例病例均行显微手术治疗,其中8例采用正中孔入路、7例采用正中孔?小脑蚓部入路、9例经小脑延髓裂入路;囊泡完整娩出17例,破裂5例,穿刺抽取囊液后再分离切除囊壁2例。术后患者脑室系统均明显回缩、颅内高压症状消失;19例(79.17%)恢复良好,小脑出现共济失调或症状加重5例(20.83%),前者经治疗1~2周恢复。结论 经小脑延髓裂入路安全、损伤小,是目前治疗第四脑室囊尾蚴病较好的手术入路。

关键词: 脑囊尾蚴病, 第四脑室, 临床特征, 显微手术, 治疗效果

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