중두개와 지주막낭종의 미세수술적 개창술

Other Titles
Microsurgical fenestration of middle cranial fossa arachnoid cyst
Authors
정성훈
Issue Date
2005-06
Awarded Date
2005
Abstract
중두개와 지주막낭종에 대한 적절한 수술적 치료법에 대하여서는 논란이 있다. 그 치료법으로는 제거, 낭종단락술, 개창술 등이 있는데, 중두개와 지주막 낭종에 대한 수술적 치료 결과를 분석해 보았다. 1995년에서 2003년 사이에 본원에서 중두개와 지주막낭종에 대해 수술적 치료를 받은 18명의 환자에 대해 후향적으로 분석하였고, 환자의 나이, 성, 발생부위, 임상증상, 치료방법, 합병증 등에 대해 분석하였다. 18명이 중두개와 지주막낭종으로 치료를 받았는데, 환자의 연령은 2세에서 44세 사이로 평균 16.4세였고, 평균 추적관찰기간은 31.48개월이었다. 남자가 15명, 여자가 3명으로 여자에서보다 남자에서 많았다. 10명이 좌측에 병소가 있었다. 임상 증상은 두통이 가장 많았고, 경련이 그 다음으로 많았다. 이중 Galassi Type I이 2명, Galassi Type II가 11명, Galassi Type III가 5명이었다. 치료후 77.8%에서 낭종의 감소가 있었고, 이중 67.3%에서는 낭종의 완전 소실이 관찰되었다. Type I cyst의 100%, Type II cyst의 81.8%, Type III cyst의 60%에서 낭종 크기의 감소가 있었다. 합병증으로는 두통, 뇌막염, 뇌수두증이 있었다. 개창술을 시행받은 환자에서 적은 합병증으로 좋은 결과를 얻을 수 있었는데, 중두개와 지주막 낭종에 대한 미세수술적 개창술은 좋은 치료방법 중의 하나일 것이라 생각된다. The optimal surgical treatment for symptomatic middle cranial fossa arachnoid cysts is controversial. Therapeutic options include excision, cyst shunting, and craniotomy for fenestration. We reviewed the result of surgically treated middle cranial fossa arachnoid cyst. We performed a retrospective study in 18 cases middle cranial fossa arachnoid cyst who were treated with surgery between 1995 to 2003. The analysis was based on the results of patients age, sex distribution, developed area, clinical symptom, treatment method, and complication. Eighteen middle cranial fossa arachnoid cyst in 18 treated patients were identified. The age range of cyst development was between 2 years to 44 years with the average age of 16.4 years. The follow-up periods averaged 31.48 months. There were 15 male and 3 female patients, with significantly more cyst development in males than females. Ten cysts were on the left side. The most common clinical symptom was headache, followed by seizure. Those cases with the middle cranial fossa involvement included 2 cases of Galassi Type Ⅰ, 11 cases of Galassi Type Ⅱ, 5 cases of Galassi Type Ⅲ. In the entire series, 77.8% of patients demonstrated decease in cyst size in serial imaging studies. Of those patient, 67.3% demonstrated complete cyst effacement. Overall, 100% of patients with Grade Ⅰ cysts, 81.8% of patients with Grade Ⅱ cysts, 60% of patients with Grade Ⅲ cysts exhibited evidence of decreases in cyst size in long-term monitoring. Complications included headache, meningitis and hydrocephalus. Patients who performed fenestration were showed good outcome with few complication. We concluded that microsurgical fenestration is the most appropriate surgical method for middle cranial fossa arachnoid cysts.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/11938
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3. 학위논문 > 1. School of Medicine (의과대학) > 석사
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