Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children--a clinical entity difficult to detect on neuroimaging study

Slit ventricle syndrome, known to occur from malfunction of the shunt procedure for hydrocephalus, is reported after cyst-peritoneal shunt for temporal arachnoid cyst. Two children aged 12 and 10 years, who underwent cyst-peritoneal shunting for a large temporal arachnoid cyst at the age of 10 and 5 years, respectively, recently experienced several episodes of severe headache. Prior to admission, repeated CT scans did not reveal any morphological change in either of these two patients. Evidence of high intracranial pressure by lumbar tap revealed shunt malfunction. Both patients became free of neurological complaints and deficits after shunt revision. Despite elevated intracranial pressure due to shunt malfunction, neuroimaging studies showed no morphological changes in slit ventricle syndrome. Delay in both the diagnosis and prompt treatment may result in complete loss of visual acuity and even death. It is important to suspect this complication in patients with persistent elevated intracranial pressure symptoms and signs after any shunting procedure, regardless of unchanged neuroimaging studies. Once this is suspected, lumbar tap may be necessary and the choice of treatment is shunt revision.     

儿童蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征的治疗

目的 探讨颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现的裂隙脑室综合征的早期诊断依据,合理有效的治疗方法以及预防这种并发症的措施.方法 回顾性分析研究了经过本文通信作者治疗的6例颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现裂隙脑室综合征患儿的影像学资料、治疗经过和治疗结果.结果 男4例,女2例.平均发病年龄57.5个月.治疗方法为使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合使用脑室-腹腔分流.6例患者临床症状完全消失,平均随访30个月,未见症状复发.结论 使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合脑室-腹腔分流术对于裂隙脑室综合征是一种有效的治疗措施.避免使用低压的无抗虹吸作用的分流管能够有效地预防蛛网膜囊肿-腹腔分流术后出现裂隙脑室综合征.

Abstract：

Objective To investigate early diagnosis evidences, optimal therapeutic strategies and the prophylactic methods of the slit - ventricle syndrome(SVS) in the temporal lobe arachnoid cysts patients who received the cyst - peritoneal(CP) shunting.Method Six cases of SVS in the temporal lobe arachnoid cysts patients who received the CP shunting were treated by the senior author from Jan 2005 to Jan 2009.The radiological data, treatment process and therapeutic results were reviewed retrospectively.Results There were 4 male and 2 female patients.The mean age of presentation was 57.5 months.The final treatment was to change the original shunt with the programmable valve or combined with the ventricular - peritoneal(VP)shunting.All the symptoms of the patients disappeared totally, and the mean follow - up duration was 30mouths.Conclusions To use programmable shunts to substitute for the original shunt or combined with inserting a VP shunt is an optimal therapeutic method for SVS.The use of low - pressure shunts to treat the ararchoid systs should be abandoned unless dictated by specific indications.     

颅内蛛网膜囊肿治疗中的有关问题

目的 探讨颅内蛛网膜囊肿的手术指征和手术方法.方法 回顾性分析209例颅内蛛网膜囊肿患者的临床表现、影像学资料、治疗方法等临床资料.结果 其中198例行CT蛛网膜下腔-脑池造影,非交通性47例均行于术治疗.43例行囊肿大部切除+脑池开放术,3例行脑室-腹腔分流术,1例行囊肿-腹腔分流术.所有手术病人手术顺利,各种术式各有利弊.结论 颅内蛛网膜囊肿应根据囊肿大小、临床症状体征、与蛛网膜下腔是否交通及年龄来决定治疗方式.手术首选囊肿切除+脑池开放术.     

Slit ventricle syndrome successfully treated by a lumboperitoneal shunt

The authors present the case of a 17-year-old man with slit ventricle syndrome, presenting as progressive neurological deterioration after head trauma. Serial computed tomography scans revealed slight ventricular enlargement, suggesting shunt malfunction. Communication between the lumbar subarachnoid space and the lateral ventricles was confirmed by computed tomography cisternography. He underwent a lumboperitoneal shunt, resulting in complete resolution of the symptoms. A lumboperitoneal shunt is considered to be a promising option for the treatment of slit ventricle syndrome. [Neurol Res 1995; 17; 440-442]     

显微外科治疗颅内蛛网膜囊肿的疗效观察

目的 探讨显微手术治疗颅内蛛网膜囊肿的效果。方法 回顾性分析42例颅内蛛网膜囊肿患者采用显微手术治疗的疗效。结果 囊肿全切除23例,大部切除14例,部分切除加脑池交通术5例。术后复查CT,29例囊肿消失或明显缩小。平均随访1年,患者症状与体征均改善。结论 显微手术治疗蛛网膜囊肿疗效满意。充分建立囊腔与脑池和蛛网膜下腔的交通,是手术成功的关键。     

A case of intraventricular arachnoid cyst

A rare case of arachnoid cyst in the trigone of a lateral ventricle is reported. The patient was an 8-year-old boy who had had four episodes of convulsions prior to admission. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a cystic lesion containing fluid resembling cerebrospinal fluid. Although he received a cyst-peritoneal shunt, the lesion did not decrease in size. Direct removal of the cyst was then scheduled. The entirc cyst was finally removed, although it was firmly attached to the choroid plexus. The enlarged trigone gradually decreased in postoperative CT. The effectiveness of a cyst-peritoneal shunt is not always satisfactory. We recommend total resection of the cyst without use of a shunt system.     

颅内蛛网膜囊肿研究进展

当前国内外对颅内蛛网膜囊肿(arachnoid cyst,AC)的研究越来越多,但在其发病机制、临床特征、诊断及治疗方法等方面仍存在较多的争议.囊肿的手术指征及手术方式也是目前争论的焦点之一.随着神经内镜技术的引进,越来越多的神经外科医生偏爱于神经内镜手术,但内镜治疗的可靠性即远期疗效仍缺乏长期的大宗的病例随访.AC是脑实质外非肿瘤性的良性病变,约占颅内占位性病变的1%~([1]).随着影像学设备的普遍运用,颅内囊肿的发现率有明显上升趋势.AC常多见于小孩,常因外伤后影像学检查发现,也因囊肿扩大或出血产生临床症状而发现.本文参阅了近几年国外文献研究进展,对AC的发病机制、诊断及治疗方法综述如下.     

应用神经内镜治疗颅内蛛网膜囊肿

目的 探讨应用神经内镜治疗颅内蛛网膜囊肿的适应证、手术方法和效果.方法 2009年6月至2011年11月,应用神经内镜治疗颅内蛛网膜囊肿51例,均行囊肿壁部分切除+囊肿与蛛网膜下腔和脑池造瘘沟通术.结果 51例症状消失,随访到37例,行CT和MRI扫描囊肿消失9例,囊肿体积缩小1/2以上18例,另10例缩小1/3.结论 神经内镜治疗颅内蛛网膜囊肿安全、微创、效果明确,应作为首选的治疗方法.     

手术治疗颅内蛛网膜囊肿及其正常灌注压突破的防治

目的 分析不同手术方式治疗颅内蛛网膜囊肿(IAC)37例的疗效,探讨手术治疗IAC时正常灌注压突破(NPPB)的预防措施及治疗方法.方法 24例行囊肿切除及脑池交通术,3例行囊肿切除术,10例行神经内镜下造瘘术.结果 术后平均随访7月,34例症状或体征有不同程度改善,2例无明显改善,1例死亡.2例发生NPPB(1例治愈,1例死亡),头颅CT或MRI提示囊肿较大,占位效应明显,有小脑幕上抬或颅骨变形、受压征象.内镜手术病例中未发生NPPB.结论 显微手术疗效确切,是大多数IAC的首选治疗方法;如预计发牛NPPB可能性较高,可行神经内镜下造瘘术;头颅CT或MRI可为选择手术方式提供参考;大剂量脱水、激素治疗对NPPB有效.     

Pseudotumor syndrome in treated arachnoid cysts

We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism — specifically, a disturbance of the cerebrospinal fluid circulation.     

Intracranial pressure monitoring using a programmable pressure valve and a telemetric intracranial pressure sensor in a case of slit ventricle syndrome after multiple shunt revisions

A case of hydrocephalus showing slit ventricle syndrome after multiple shunt revisions was treated with a programmable pressure valve, and intracranial pressure was monitored with a telemetric sensor. High pressure setting produced positive and normal values of intracranial pressure in this patient. We report our experiences.     

带蒂颞肌填塞治疗颅内巨大症状性蛛网膜囊肿(附6例报告)

目的 探讨颅内巨大症状性蛛网膜囊肿形成因素及治疗方法。方法 总结1998～2002年收治临床少见6例颅内巨大蛛网膜囊肿病因及采用带蒂颞肌填塞治疗的临床经验。结果 采用带蒂颞肌肌瓣填塞巨大颅内蛛网膜囊肿腔可发挥其强大的吸收作用，脑组织可逐渐膨胀，术后两周CT复查囊肿明显缩小，6～8月后复查囊肿消失，辅以抗癫痫药物应用，未见癫痫再发作。结论 由于外伤、炎症或手术后引起蛛网膜周围软脑膜粘连及较晚出现颅高压症状，病程长，确诊晚等综合因素是形成少见颅内巨大蛛网膜囊肿的主要原因。对病史中有间歇癫痫发作伴头部外伤、颅内炎症或颅脑手术史患者，应尽早做头颅CT检查，以排除IAC或明确IAC存存，避免颅内巨大IAC形成。采用带蒂颞肌填塞治疗．简便实用，安全可靠．效果满意，为治疗少见颅内巨大蛛网膜囊肿的较好方法．     

Short-term dexamethasone treatment for symptomatic slit ventricle syndrome

Objective The objective was to report our positive experience of using dexamethasone to treat 13 patients with symptomatic slit ventricle syndrome (SVS).Methods Thirteen SVS patients who received dexamethasone during acute episodes were studied. The etiology for hydrocephalus was prematurity and intraventricular hemorrhage in 9 patients and neonatal meningitis, chorioamnionitis, Dandy–Walker variant, and congenital in 1 case each. The shunt was inserted at 1.8±1.0 months of age and SVS was diagnosed at 4.9±3.2 years of age.Results All patients reported relief and shorter duration of symptoms with dexamethasone. Surgical intervention was decided upon and carried out within 11±8 months of SVS diagnosis in 9 out of 13 patients. The other 4 are being monitored and continue to receive dexamethasone when needed.Conclusions Dexamethasone appears to be a useful treatment in acutely increased intracranial pressure caused by SVS. It can provide temporary relief during the decision-making process of whether and when to perform surgery.A commentary on this paper is available at     

儿童颅内蛛网膜囊肿的治疗

目的探讨儿童颅内蛛网膜囊肿的临床特点、手术适应证、手术方法及手术中应注意的问题。方法回顾我院30例儿童颅内蛛网膜囊肿的临床资料,对其进行总结。结果经显微手术治疗的30例中,症状明显改善28例,囊肿缩小或消失25例。结论显微手术能有效治疗儿童颅内蛛网膜囊肿,对儿童颅内蛛网膜囊肿需采取积极的手术治疗。     

颅内蛛网膜囊肿的治疗策略

目的 探讨颅内蛛网膜囊肿治疗策略.方法 作者回顾分析于2010年9月1日至2010年12月1日在北京天坛医院神经外科门诊诊治的有完整临床资料的47例颅内蛛网膜囊肿,无干预治疗25例,手术治疗22例,神经内镜下蛛网膜囊肿壁部分切除+囊肿-脑池造瘘术13例,囊肿-腹腔分流术7例,显微下切除囊肿壁术2例.结果 无干预治疗25例,平均随访38.9个月,囊肿无变化.神经内镜治疗组,囊肿消失1例,囊肿缩小50%以上12例;分流治疗组,囊肿消失1例,缩小50%以上5例,无变化1例;显微手术治疗组,囊肿1例消失,1例无变化.并发症:神经内镜组,1例发现硬膜下积液;分流组中3例脑组织包裹分流管,1例硬膜下积液.结论 大多数颅内蛛网膜囊肿行无干预治疗;神经内镜治疗与囊肿-腹腔分流治疗,效果相似,前者更安全、微创,并发症少,应作为首选的治疗方法.

Abstract：

Objective To investigate treatment strategy of intracranial arachnoid cysts. Method 47 cases of Intracranial arachnoid cysts from Sep 1,2010 to Des 1,2010 were analyzed. 25 cases received no intervention but follow. 22 cases received operation, 13 of 22 cases neuroendoscopic partial cystectomy and communication between cystic cavity and brain cistern; 7 of 22 cases cysts - peritoneal shunt, 2 of 22 cases cranioectomy for cystectomy. Results All the cases of no intervention group showed no neuron - imaging change,in endoscopic treatment group,cyst disappearance occurred to 1 case, 12 cases reduced over 50%. In cyst -peritoneal shunt group,cyst disappearance occurred to 1 case,5 cases reduced over 50%. In microscopic cystectomy group, cyst disappearance occurred to 1 case. But no change to 1 case. Conclusions Most of intracranial arachnoid cysts should be given intervention but followed, neuroendoscopy is a safe and effective method with minima invasion in the treatment of intracranial arachnoid cyst. It should be first choice.     

颅内蛛网膜囊肿的诊疗策略

目的探讨颅内蛛网膜囊肿（IAC）的治疗策略。方法对48例CT诊断IAC病人结合临床表现、CT平扫以及CT蛛网膜下腔一脑池造影（CTC）来判断手术指征。结果26例行手术治疗,22例行保守治疗。行手术治疗的26例患者中,失访2例,24例术后症状改善或消失。未行手术治疗的22例患者中,失访6例,症状改善6例,症状仍间断发作,药物可控制但效果不佳10例。结论具有明显手术指征的患者行手术治疗;手术指征不明显,能够接受CTC检查且结果为非交通性蛛网膜囊肿（NCIAC）的患者行手术治疗;交通性蛛网膜囊肿（CIAC）、手术指征不明显不愿接受CTC检查、不能接受手术治疗的患者行保守治疗,随访观察。     

颅内常见部位蛛网膜囊肿的神经内镜治疗研究

目的探讨颅内好发部位蛛网膜囊肿(IAC)的内镜手术治疗经验。方法对21例颅内蛛网膜囊肿患者的临床资料进行回顾性分析。其中12例中颅窝AC及3例鞍上池IAC患者选择内镜部分IAC切除+IAC-基底池穿通术,6例后颅窝AC患者中5例行内镜部分IAC切除+脑池穿通术,1例患者行内镜IAC大部分切除术。对患者术后症状、体征以及并发症进行分析。结果 21例患者(1例失随访)中症状消失9例,改善9例,无明显变化2例。影像学复查显示,IAC张力消失3例,与术前相比,囊腔缩小、脑组织膨胀饱满14例,无明显变化3例。结论 IAC部分切除+囊肿-脑池穿通术的治疗效果较好,应作为影像学检查示与脑池、脑室比邻的AC患者的首选手术方式。     

症状性颅内蛛网膜囊肿的临床治疗分析

目的 探讨症状性颅内蛛网膜囊肿(IAC)的手术治疗方法、适应证及其治疗效果.方法 回顾性分析南通大学附属医院神经外科自2000年1月至2010年1月收治的32例IAC患者临床资料,总结其手术方法及疗效. 结果 本组2例保守治疗的患者失随访.随访结束时,23例(72％)患者症状明显改善(囊肿体积缩小或临床症状缓解),6例(18％)患者症状无改变(临床症状和囊肿大小无改变),1例(3.1％)巨大鞍区-鞍上区IAC患者症状加重(临床症状恶化或囊肿增大);术后影像学检查显示囊肿消失4例(12.5％),囊肿缩小16例(50％),囊肿大小无改变12例(37.5％). 结论 IAC的主要手术适应证是颅内高压、确切的神经系统损害、脑组织压迫.显微外科手术以及神经内镜是治疗IAC的有效方法.     

颅内蛛网膜囊肿的临床诊治（附22例报告）

目的探讨颅内蛛网膜囊肿的临床诊治。方法回顾分析手术治疗22例颅内蛛网膜囊肿患者临床资料,术式包括蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术及囊肿-腹腔分流术等。结果17例获得良好疗效,6例癫痫患者5例症状消失。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。