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    Clinical observation of the intracranial arachnoid cysts

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    μ˜ν•™κ³Ό/석사[ν•œκΈ€]1972λ…„ 7μ›”λΆ€ν„° 1981λ…„ 8μ›”κΉŒμ§€ 9λ…„κ°„ λ³Έ μ—°μ„Έμ˜λ£Œμ› μ‹ κ²½μ™Έκ³Όμ—μ„œ κ²½ν—˜ν•œ 28λ‘€μ˜ 지주막낭쒅에 λŒ€ν•œ μž„μƒμ  고찰을 ν•˜μ—¬ λ‹€μŒκ³Ό 같은 κ²°κ³Όλ₯Ό μ–»μ—ˆλ‹€. 1. μ²œλ§‰μƒ 지주막낭쒅이 19λ‘€(67.9%)μ˜€μœΌλ©° μ²œλ§‰ν•˜ 지주막낭쒅이 9λ‘€(32.1%)λ‘œμ„œ μ²œλ§‰μƒμ—λŠ” μ€‘λ‘κ°œμ™€μ— μœ„μΉ˜ν•œ 낭쒅이 17λ‘€(60.7%)둜 κ°€μž₯ λ§Žμ•˜μœΌλ©° μ²œλ§‰ν•˜ λ‚­μ’… μ€‘μ—λŠ” 木ζͺ€(cisterna magna)에 λ°œμƒν•œ 것이 5λ‘€(17.9%)μ˜€λ‹€. μ²œλ§‰μƒ λ‚­μ’…μ˜ 쒌우 λΉˆλ„μ˜ μ°¨μ΄λŠ” μ—†μ—ˆλ‹€. 2. 성별 λΉˆλ„λŠ” λ‚¨μž 23λ‘€, μ—¬μž 5λ‘€λ‘œ 4.6:1의 λΉ„μœ¨λ‘œ μžκ°€ μ›”λ“±νžˆ λ§Žμ•˜μœΌλ©° μ²œλ§‰μƒ μ§€μ£Όλ§‰λ‚­μ’…μ˜ 경우 λ‚¨λ…€μ˜ λΉ„λŠ” 8.5:1μ΄λ‚˜ 그쀑 μ€‘λ‘κ°œμ™€ λ‚­μ’…λ§Œμ˜ λ‚¨λ…€λΉ„λŠ” 16:1둜 거의 λ‚¨μžμ—μ„œ λ‚˜νƒ€λ‚¬λ‹€. μ²œλ§‰ν•˜ μ§€μ£Όλ§‰λ‚­μ’…μ˜ λ‚¨λ…€λΉ„λŠ” 2:1μ΄μ—ˆλ‹€. μ—°λ Ή 뢄포도 μ€‘λ‘κ°œμ™€ μ§€μ£Όλ§‰λ‚­μ’…μ˜ κ²½μš°μ— 20μ„Έ λ―Έλ§Œμ—μ„œ 58.8%둜 미성년에 많고 특히 10μ„Έ λ―Έλ§Œμ—μ„œ 41.2% κ°€μž₯ λ§Žμ•˜μœΌλ©° λ‹€λ₯Έ μ—°λ ΉμΈ΅μ—μ„œλŠ” 비ꡐ적 κ· λ“±ν•œ 뢄포λ₯Ό λ³΄μ˜€λ‹€. 3. μ€‘λ‘κ°œμ™€ μ§€μ£Όλ§‰λ‚­μ’…μ˜ ν•©λ³‘μ¦μœΌλ‘œ λ§Œμ„± κ²½λ‡Œλ§‰ν•˜ν˜ˆμ’…μ΄ 4λ‘€(23.5%), κ²½λ‡Œλ§‰ν•˜μˆ˜ν™œμ•‘λ‚­μ’…μ΄ 1λ‘€(5.9%)μ—μ„œ λ‚˜νƒ€λ‚¬μœΌλ©°, μ²œλ§‰ν•˜ λ‚­μ’…μ—μ„œ λ‡Œμˆ˜μ’…μ΄ 6λ‘€(66.7%)μ—μ„œ λ™λ°˜λ˜μ—ˆλ‹€. 4. κ°€μž₯ ν”ν•œ μž„μƒμ¦μƒμ€ λ‘ν†΅μœΌλ‘œ 21λ‘€(75%)μ—μ„œ λ³΄μ˜€κ³  μ²œλ§‰μƒ, ν•˜μ˜ λΉˆλ„λŠ” λΉ„μŠ·ν•˜μ˜€μœΌλ‚˜ μ²œλ§‰μƒμ—μ„œλŠ” λ‡Œμ••μƒμŠΉμ΄ μ—†λŠ” κ²½μš°μ—λ„ 8λ‘€(61.5%)μ—μ„œ 두톡을 λ³΄μ˜€λ‹€. μž„μƒμ¦μƒμ˜ λΉˆλ„ μˆœμ€ μ²œλ§‰μƒ, ν•˜μ—μ„œ 두톡, λ‡Œμ••μƒμŠΉ 증상, 신경학적 μ΄μƒμ†Œκ²¬, 경련의 μˆœμ„œλ‘œ λ‚˜νƒ€λ‚¬λ‹€. 5. μ€‘λ‘κ°œμ™€ μ§€μ£Όλ§‰λ‚­μ’…μ˜ 12λ‘€(70.6%)μ—μ„œ λ‘κ°œκ³¨λ³€ν˜•μ„ λ³Ό 수 μžˆμ—ˆκ³  λ‡Œμ „μ‚°ν™”λ‹¨μΈ΅μ΄¬μ˜μœΌλ‘œ 진단에 결정적인 μ†Œκ²¬μ„ μ–»μ—ˆμœΌλ©° λ‡Œλ™λ§₯쑰영술둜 κ°λ³„μ§„λ‹¨μ˜ λ‹¨μ„œλ₯Ό 얻을 수 μžˆμ—ˆλ‹€. 6. 17λ‘€μ˜ 수술둜 얻어진 κ²½ν—˜μœΌλ‘œ 보아 νŠΉμˆ˜λ‘€λ₯Ό μ œμ™Έν•œ λŒ€λΆ€λΆ„μ˜ 경우 선택할 λ§Œν•œ μΉ˜λ£Œλ²•μ€ κ°œλ‘μˆ  및 λ‚­μ’…μ œκ±°μˆ λ‘œμ„œ μ΄λ•Œ 낭쒅을 μ΄λ£¨λŠ” 지주막을 μ ˆκ°œν•˜μ—¬ μΈμ ‘ν•œ μ§€μ£Όλ§‰ν•˜ 곡간 λ˜λŠ” 梲槽(cistern)와 λ‡Œμ²™μˆ˜μ•‘μ˜ ν†΅λ‘œλ₯Ό λ§Œλ“€μ–΄ μ£ΌλŠ” 것이 μ€‘μš”ν•œ 점으둜 μƒκ°λ˜μ—ˆλ‹€. 낭쒅이 ν¬κ±°λ‚˜ 심뢀에 μœ„μΉ˜ν•œ κ²½μš°μ—λŠ” 낭쒅볡강간 λ„κ΄€μˆ μ„ μ„ νƒν•˜λŠ” 것이 더 λ°”λžŒμ§ν•˜μ˜€λ‹€. μ²œλ§‰ν•˜ λ‚­μ’…μ—μ„œ λ‡Œμˆ˜μ’…μ„ λ™λ°˜ν•œ μ¦λ‘€μ—μ„œλŠ” λ‡Œμ‹€λ³΅κ°•κ°„ λ„κ΄€μˆ μ„ ν•„μš”λ‘œ ν•˜μ˜€λ‹€. λͺ¨λ“  지주막낭쒅은 μˆ˜μˆ ν›„ μ •κΈ°μ μœΌλ‘œ λ‡Œμ „μ‚°ν™”λ‹¨μΈ΅μ΄¬μ˜μ„ μ‹œν–‰ν•˜μ—¬ λ‚­μ’…μ˜ 재발, 합병증 유무, λ‡Œμˆ˜μ’…μ˜ ν•΄κ²°μ—¬λΆ€ 등을 μΆ”μ ν•˜λŠ” 것이 μ€‘μš”ν•  κ²ƒμœΌλ‘œ μƒκ°λœλ‹€. [영문]Twenty eight intracranial archnoid cysts were experienced from July, 1972 to August, 1981, of which 17 cases were operated. The clinical analysis and surgical experiences were summarized as follows. 1. The supratentorial cysts were 67.9% and the infratentorial cysts were 32.1% of the intracranial arachnoid cysts. The predilection sites were middle cranial fossa of the supratentorial (60.7%) and the inferior midline of the infratentorial (17.9%). 2. The middle fossa arachnoid cysts were prominent in males under the age of 20. 3. The common complicating lesions in the supratentorial arachnoid cysts were chronic subdural hematoma(23.5%) and subdural hygroma(5.9%). Hydrocephalus was usually combined with the infratentorial arachnoid cyst (66.7%). 4. The most frequent symptom was headache(75%) with similar frequency in both supratentorial and infratentorial lesions. In the supratentorial cysts, headache was also complained with highest frequency even in cases without increased intracranial pressure(61.5%). The main clinical features of arachnoid cysts were headache, signs of increased intracranial pressure, other neurologic deficits and seizure in order of frequency. 5. Cranial deformities on the plain X-ray files were observed in 70.6% of middle fossa cysts . The brain CT scan provided a definite diagnostic information, while the cerebral angiography offered clues for differential diagnosis. 6. The direct intracranial approach was selected as a curative measure in most cases and the essential step in this procedure was thought to establish a communication between the cyst and the basal cistern or adjacent subarachnoid space. But in a few special cases such as deep-seated cysts or extensively large ones, a cystoperitoneal shunt was a more preferable procedure . The infratentorial cysts with hydrocephalus almost always required ventriculoperitoneal shunt in this series. It was considered to be very important to perform periodic follow-up brain CT scan to detect a recurrence of cyst or recollection of the cerebrospinal fluid, postoperative complications and persistent hydrocephalus.restrictio
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