Brain Tarlov cystectomy

Arachnoid cysts are benign lesions that can occur in various parts of the brain, such as the lateral fissure, anterior temporal lobe, cerebral convex surface, cerebral hemisphere longitudinal fissure, saddle area, quadrilateral, slope, cerebellar pons, and posterior cranial fossa midline. . Pathology can be divided into two categories: one is true arachnoid cyst, the cyst wall is composed of a thin layer of arachnoid membrane, the capsule contains cerebrospinal fluid, which is not connected with the surrounding subarachnoid space, mostly congenital; Different secondary factors, such as trauma, inflammation or surgery, due to arachnoid adhesions, cerebrospinal fluid accumulates in the subarachnoid space into a cystic cavity, often with a small channel associated with the subarachnoid space, cerebrospinal fluid into the sac, Gradually increase. This type of cyst is called a subarachnoid cyst and is not a true arachnoid cyst. The cysts increase, slowly causing compression of the adjacent brain, and can cause increased intracranial pressure, headache, cranial nerve dysfunction, epilepsy, limb weakness and other symptoms. Depending on the cyst site, the clinical symptoms can be very different. Some large arachnoid cysts can be completely free of symptoms, while some very small cysts are very obvious. Imaging examination, X-ray plain film of lateral fissure cyst often has signs of thinning and swelling of the sacral scaly, and local bulge. Children with this condition are similar to hydrocephalus due to enlarged head. CT and MRI have the most diagnostic value, and can show low-density or low-signal intracranial cystic space-occupying lesions. The cystic content is equivalent to cerebrospinal fluid, and there is no enhancement effect on the cyst wall. Treating diseases: arachnoid cysts Indication Cerar Tarlov cystectomy is suitable for cysts in various parts. It has caused clinical symptoms, or although there are no obvious symptoms, but the cysts are large and suitable for surgery. Contraindications Older age, cysts have existed for many years, no obvious neurological symptoms and increased intracranial pressure, especially organic heart disease and diabetes, etc., should not be operated. Preoperative preparation 1. CT or MRI examination to determine the location and extent of arachnoid cysts. 2. Press the preoperative preparation for craniotomy. Surgical procedure Incision The surgical approach and incision are determined according to the cyst site. Lateral arachnoid cysts, with a small incision or a straight incision for craniotomy, can meet the needs of surgery. A cyst in the saddle or on the saddle, with a resection of the pituitary gland under the frontal lobe. Four-body cysts, reference to the posterior occipital lobe of the third ventricle posterior tumor resection or suboccipital cerebellar approach for pineal tumor resection. Subscopial cysts, according to the location of the posterior midline or cerebellar pons, respectively, using the suboccipital midline straight incision or posterior mastoid (post sigmoid sinus) side incision. 2. revealing lesions Routine craniotomy, incision of the dura mater. Shallow cysts such as the lateral fissure and the cyst of the cerebral convex surface can be found. The brain tissue of the cyst is compressed, and the part presents a large gap. The wall of the cyst is transparent, thin, and contains clean, colorless and transparent cerebrospinal fluid. The arachnoid cysts such as the chiasm, tetrad, and cerebellar cerebral horn are easily found after retracting the brain tissue. During the exploration, avoid premature tearing of the arachnoid membrane, and further identify the extent of the cyst, the adjacent relationship between the cyst and the surrounding brain tissue, nerves, and blood vessels. 3. Remove the cyst The wall of such a cyst usually contains no blood vessels. When exploring and freeing the wall, the arachnoid of the wall layer can be removed, and the arachnoid of the inner layer is determined according to the adhesion condition, and all or part of the ablation is performed. Generally do not cause major bleeding. Microsurgery facilitates the removal of deep arachnoid cysts. 4. suture the wound According to the routine craniotomy, the skull is closed. complication 1. When dealing with deep arachnoid cysts, accidentally injure important brain tissue and nerves and blood vessels. 2. Wound infection.