儿童颞部蛛网膜囊肿不同术式的疗效分析

目的探讨儿童颅内颞叶蛛网膜囊肿的手术方法和疗效。方法颞部蛛网膜囊肿患儿65例,27例行囊肿-腹腔分流术,17例行显微镜下囊壁剥离＋脑池穿通术,21例行内镜下囊壁剥离＋脑池穿通术,并比较三种不同术式的治疗效果。结果囊肿-腹腔分流术、显微镜和内镜术后囊肿缩小率分别为88.9%、94.1%和95.2%,三者相比,无显著性差异（P〉0.05）。术后转流障碍是囊肿-腹腔分流术的主要并发症,且经受该手术患者并发感染后治疗效果差、囊肿消失后拔管率低;术后硬膜下积液和慢性硬膜下血肿则是显微镜和内镜手术的主要并发症。结论根据囊肿形态、大小、脑脊液吸收功能等进行评估,以微创为主导个体化选择手术治疗儿童颞部囊肿,可取得较满意效果。     

颅内外侧裂池蛛网膜囊肿的治疗(附18例报告)

目的分析颅内外侧裂池蛛网膜囊肿的临床特征,显微手术治疗的优越性、疗效及术中应注意的问题。方法手术治疗外侧裂池蛛网膜囊肿１８例,其中,囊肿穿刺抽吸２例,囊肿外侧包膜切除２例,囊肿腹腔分流２例,显微手术囊肿全切除３例,囊肿大部切除加脑池交通术９例。结果术后平均随访８年,３例复发,１例治疗失败,其余患者症状及体征均有明显改善。ＣＴ随访１４例,６例囊腔明显缩小,５例稍有缩小,３例无变化。结论显微镜下囊壁切除加脑池交通术是较理想的手术方法,囊肿较大且与蛛网膜下腔交通者以囊肿腹腔分流术疗效较佳。     

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.     

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。     

颅内蛛网膜囊肿的诊疗特点(附26例报告)

目的探讨颅内蛛网膜囊肿(IAC)的诊断和治疗特点。方法对2005年10月至2008年6月收治的26例IAC患者的临床资料进行回顾性分析。26例IAC的诊断以临床症状和体征结合CT、MRI及术后病理检查来确诊。治疗以手术治疗为主,21例行囊肿壁部分切除术加囊腔与脑池蛛网膜下腔交通术,1例行囊肿-脑室引流术,2例行囊肿-腹腔分流术,2例行显微外科囊壁全剥离术。结果术后患者症状和体征均有显著改善,CT复查囊肿有所缩小或消失。术后0.5~5.5年,随访的21例症状和体征进一步好转或消失。结论 CT及MRI为IAC诊断最主要和可靠的方法,对小囊肿及近中线旁的深部囊肿,MRI检查优于CT。对IAC手术应依其大小、部位及临床症状不同而综合考虑,凡囊肿伴有颅内压增高,引起神经系统器质性或功能性损伤者均应手术,手术时应尽可能切除囊壁;应用显微外科技术是囊壁全剥离的关键,目的是建立囊腔与邻近脑池、蛛网膜下腔或脑室的交通。     

儿童颅内幕上蛛网膜囊肿的手术治疗

目的总结儿童颅内幕上蛛网膜囊肿手术治疗的经验。方法回顾性分析56例幕上蛛网膜囊肿病儿的临床资料,均经手术治疗,手术方法包括囊肿壁部分切除加囊肿脑池交通术30例,囊肿壁部分切除并囊肿脑池交通加颞肌条填入术20例,囊肿-腹腔分流术5例及神经内镜下囊肿壁部分切除并造瘘术1例。结果病儿术后临床症状均不同程度改善,颅内压增高症状术后均消失。术后高热(39℃)12例,并发颅内血肿4例,无手术死亡。随访3个月～5年,囊肿消失18例,缩小80%以上22例,缩小50%～80%8例,无明显变化6例;2例合并脑积水者,1例脑室较术前略缩小,另1例无变化。结论外科手术是儿童颅内幕上蛛网膜囊肿的有效治疗方法,术中仔细和轻柔操作是预防和减少相关手术并发症的关键。     

41例颅内蛛网膜囊肿诊断与治疗

目的 研究应用囊肿腹腔分流术、显微外科微创技术切除颅内蛛网膜囊肿的方法。方法采用4种微创手术方式治疗35例颅内蛛网膜囊肿,其中囊肿完整切除术14例,囊肿切除并脑池开放手术10例。囊腔一腹腔分流术9例,囊肿部分切除并带蒂颞肌瓣置人术2例。结果术后随访3个月以上,症状改善率80％,CT证实囊肿消失或明显缩小者90．4％。不同术式比较,囊肿切除并脑池开放手术效果最好,其症状改善率达92．68％,囊肿缩小者占90.24％。结论采用微创技术治疗颅内蛛网膜囊肿,手术损伤小,疗效可靠。囊肿切除并脑池开放手术,充分建立囊腔与周围脑池或腹腔之间的交通,是手术成功的关键。     

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。     

儿童颅内蛛网膜囊肿大部分切除-脑池交通术

我院自1991年1月-2000年10月共收台颅内蛛网膜囊肿（intracranial arachnoid cyst,IAC）患21例，均施行手术治疗，其中6例颅中窝侧裂池蛛网膜囊肿实施囊壁大部分切除-脑池交通术，效果良好。     

颅内蛛网膜囊肿的诊断和治疗（附63例临床分析）

目的:收集63例颅内蛛网膜囊肿,分析其临床表现、手术方式。方法;该囊肿症状多样,CT和MRI有特征性表现,手术以囊壁大部分切除 脑室脑池沟通术为主。结果:手术51例,症状明显改善47例;余12例无特殊治疗,临床观察随访无特殊变化。结论:颅内蛛网膜囊肿症状隐匿,CT或MRI检查可明确诊断,手术中应充分建立囊腔和脑池之间的交通。     

Assessment of endoscopic treatment for middle cranial fossa arachnoid cysts

Background

Endoscopic cystocisternotomy is one of three surgical methods used to treat middle cranial fossa arachnoid cysts. There is debate about which method is the best.

Objective

The aim of this study is to evaluate the effectiveness and safety of endoscopic cystocisternotomy for treatment of arachnoid cysts of the middle cranial fossa.

Methods

Thirty-two patients with arachnoid cysts of the middle cranial fossa who had undergone endoscopic cystocisternal fenestration between 2004 and 2009 were studied retrospectively. Data were obtained on clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and the results of clinical and neuroradiological follow-up.

Results

Among the 27 patients with symptoms before surgery, 8 had disappearance of symptoms and 17 had improvement of symptoms. The cyst was reduced in size or it completely disappeared in 24 (75%) patients. The incidence rate of complications was 18.8%.

Conclusions

Endoscopic cystocisternal fenestration is an effective treatment for symptomatic arachnoid cysts of the middle cranial fossa and should be the initial surgical procedure.     

颅内蛛网膜囊肿伴发癫痫的手术治疗

目的 通过对37例颅内蛛网膜囊肿(intracranial arachnoid cyst,IAC)伴发癫痫患者手术治疗情况的回顾分析,以期对此类患者手术方法的选择提供依据.方法 25例患者归为囊肿手术组,方法有囊肿壁切除术、囊肿-腹腔分流术和囊肿造瘘术;12例患者归为癫痫手术组,行囊肿壁切除术同时,切除囊肿周围萎缩变性致痫脑组织,如果患者残存颞叶内侧及杏仁核、海马结构,也予以切除,如囊肿周围邻近功能区,则通过体感诱发电位确定中央沟后于功能区行多处软膜下横切术,必要时行脑皮质离断术和胼胝体切开术,12例均行术中皮层脑电图监测.结果 术后37例患者中6例囊肿消失,17例减小,14例无变化,两组相比无显著性差异;囊肿手术组2例无发作,8例改善,15例无效,手术总有效率40%;癫痫手术组7例无发作,3例改善,2例无效,手术总有效率83.3%,两组相比有显著性差异(P＜0.05).结论 IAC伴发癫痫患者术前进行癫痫灶的确认,术中行囊肿壁切除术同时切除癫痫灶,大大提高IAC伴发癫痫的手术疗效.     

Symptomatic supratentorial arachnoid cysts in children

This study was undertaken to evaluate the clinical and radiologic long-term outcome of symptomatic primary arachnoid cysts in pediatric patients. Thirty-three children, ranging from 2 months to 17 years of age (mean age, 6 years) were treated. Craniotomy and fenestration of the cyst were used for temporal fossa and midline cysts in 24 patients (73%); later, two patients required shunt placement. Shunting device implantation was performed for cerebral convexity cysts in nine patients (27%), and two patients required a subsequent craniotomy and fenestration of the cyst. Four patients (12%) required additional surgery because of clinical progression rather than for cyst enlargement. Eleven patients (33%) experienced a cyst reduction of more than 50% compared with the original size on imaging studies. There was a significant correlation with the alleviation of symptoms (P < 0.005), regardless of the treatment used. Complete alleviation of symptoms was achieved in all patients after treatment, regardless of cyst reduction. Long-term follow-up of 70 +/- 9.3 months demonstrated no recurrence of symptoms or progressive enlargement of the arachnoid cyst in all children.     

儿童颅内蛛网膜囊肿的外科干预

目的 探讨小儿颅内蛛网膜囊肿的治疗方法.方法 收治15岁以下颅内蛛网膜囊肿患者37例,其中手术切除囊肿壁同时打通颅底蛛网膜池12例,囊肿-腹腔分流术20例,神经内镜造瘘术5例.对患者术后症状体征改善、影像学囊肿变化以及术后并发症等进行回顾性对比分析.结果 37例患者神经系统症状和体征均有不同程度的改善.影像学随访结果表明无论是哪种方法均能够使囊肿有不同程度的缩小,脑组织膨隆比较理想.改善情况并未因手术方式的不同而存在明显的差异(P>0.05).但开颅手术组并发症发生率明显高于分流组和神经内镜组.结论 囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿具有近期效果明显和并发症少的优点.

Abstract：

Objective Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1 % of all intracranial space-occupying lesions.So far, the optimal method of treatment for symptomatic arachnoid cysts remains controversial.In this article,we want to find an ideal technique to deal with this condition.Method The hospital records of 37 consecutive patients with intracranial arachnoid cysts who were treated in Tianjin Huanhu Hospital between January 2004 and December 2009, were analyzed retrospectively.All the patients were children below the age of 15 years old with an average of 6, 7 years old.The diagnosis of arachnoid cyst was based on computerized tomography (CT) and MRI scan findings demonstrating a well-circumscribed and non-enhancing cystic lesion that had attenuation values similar to those of the cerebrospinal fluid ( CSF) and did not communicate with the ventricular system.They were divided into three groups as follow, group A ( 12 patients ) , open craniotomy; group B ( 20 patients ) , cyst-peritoneal shunting, and group C(5 patients), endoscopic fenestration.Results The symptoms and neurological signs were improved more or little in all the 3 group patients who accepted the neurosurgical treatment.There were no significant differences between among the 3 groups in releasing of the symptom and sign caused by cysts.On the other hand,there were high percentage of complications,including intracranial infections and subdural fluid collections in the group A.Conclusions The technique of cysto-peritoneal shunting is likely the optimal method for treating the intracranial arachnoid cysts in children.     

神经内镜手术治疗颅内蛛网膜囊肿

目的 探讨神经内镜手术治疗颅内蛛网膜囊肿的手术指征、手术方法和预后。方法 回顾性分析26例采用神经内镜手术治疗的颅内蛛网膜囊肿，其中采用神经内镜下囊肿脑池造瘘和囊壁部分剥除18例，囊肿次全切除3例，囊肿脑室造瘘5例(1例尚行脑室腹腔分流术)。术后随访3个月-2年。结果 术前有症状的20例患者中，症状消失11例，改善7例，无变化2例，术后不能改善的症状主要是癫痫。有随访影像学复查结果的16例患者中，囊肿消失6例，缩小7例，无变化3例。结论 神经内镜手术是治疗颅内蛛网膜囊肿有效和微创的方法。     

The clinical classification and treatment of middle cranial fossa arachnoid cysts in children

Objective

The optimal management for middle fossa arachnoid cysts (MFAC) remains controversial, but cystocistern fenestration is effective. MFACs are divided into non-communicating arachnoid cysts (NCIAC) and communicating arachnoid cysts (CIAC). This retrospective observational study evaluated the role of phase-contrast cine magnetic resonance imaging (PC-MRI) in the diagnosis and postoperative evaluation of MFACs and assessed surgical outcomes.

Methods

Twenty-eight children with MFAC that were diagnosed by conventional neuroradiology were enrolled. PC-MRI was performed preoperatively. The clinical manifestations, cyst volumes and PC-MRI data were analyzed, and the flow of cerebrospinal fluid (CSF) at the fistula was qualitatively evaluated.

Results

No communication with the adjacent subarachnoid space was found on preoperative PC-MRI in 20 patients, and they were diagnosed with NCIAC. A statistically significant decrease in cyst volume was observed in all 20 patients postoperatively. Symptoms resolved or improved in the 14 patients who were symptomatic preoperatively, and a positive CSF flow was found in all 20 patients postoperatively. PC-MRI diagnosed eight patients with CIAC, and the cyst sizes did not increase during follow-up.

Conclusions

Cystocistern fenestration is an effective treatment for children with lateral fissure IAC. PC-MRI can be used to determine the IAC type and to evaluate the effectiveness of cystocistern fenestration.     

Operative management of idiopathic spinal intradural arachnoid cysts in children: a systematic review

Background

Spinal intradural arachnoid cysts are rare with only a few patients reported so far. Idiopathic, traumatic, posthemorrhagic, and postinflammatory causes have been reported in the literature. Especially, idiopathic lesions, in which other possible etiological factors have been ruled out, seem to be rare.

Patients and Methods

We systematically reviewed the literature in regards to localization within the spinal canal, treatment options, complications, and outcome. Additionally, we present management strategies in two progressively symptomatic children less than 3 years of age with idiopathic intradural arachnoid cysts.

Results

In total, 21 pediatric cases including the presented cases have been analyzed. Anterior idiopathic spinal arachnoid cysts are predominantly located in the cervical spine in 87.5 % of all cases, whereas posterior cysts can be found at thoracic and thoracolumbar segments in 84.6 % of the patients. Most children presented with motor deficits (76.2 %). Twenty-five percent of anterior spinal arachnoid cysts caused back pain as the only presenting symptom. Open fenestration by a dorsal approach has been used in the vast majority of cases. No major surgical complications have been reported. Ninety-four percent of all patients did improve or showed no neurological deficits. Recurrence rate after successful surgical treatment was low (9.5 %).

Conclusion

Idiopathic spinal intradural arachnoid cysts can present with neurological deficits in children. Pathologies are predominantly located in the cervical spine anteriorly and in thoracic and thoracolumbar segments posteriorly to the spinal cord. In symptomatic cases, microsurgical excision and cyst wall fenestration via laminotomy are recommended. Our radiological, intraoperative, and pathological findings support the cerebrospinal fluid obstruction and vent mechanism theory of arachnoid cysts.     

Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children

The best operative intervention for children with arachnoid cysts remains the subject of controversy. Recent reports stress that craniotomy for cyst fenestration is associated with a low incidence of morbidity and mortality and may leave the child shunt-independent. Among a total of 66 intracranial arachnoid cysts operated on in the authors’ department from 1985 to 1997, 44 cases (67%) were located in the middle cranial fossa. A higher incidence in the first decade of life (53 cases) and a marked male predominance (45 cases) were recognized. Headache, cranial deformities, symptoms of raised intracranial pressure, and seizures constituted the most frequent features of the clinical presentation. To determine which treatment provides the greatest benefit with the lowest incidence of complications, the records of the 44 patients with arachnoid cysts in the middle cranial fossa were reviewed. The mean age of these patients was 4.6 years (range 0–16 years). Different types of initial surgical procedures were performed. In 33 patients with middle cranial fossa arachnoid cysts (MCFAC) the initial surgery took the form of craniotomy with excision of the cyst walls and fenestration into the basal cisterns. Shunting procedures were performed in 9 patients: cysto-peritoneal shunts (CPS) were placed in 4 patients and ventriculo-peritoneal shunts (VPS), in 3 patients, and cyst excision was performed in addition to CPS in 2 patients. Excision of the cyst membrane alone without fenestration was performed in 2 patients. The initial treatment was successful in terms of reduced symptoms and decreased cyst size, with no additional treatment needed for the cyst, in 79% (26/33) of patients who had undergone excision of the cyst walls and fenestration into the basal cisterns, compared with 66% (6/9) of patients who had undergone shunting procedures. Cyst membrane excision was not successful in any of the patients who underwent this procedure alone. No significant difference in morbidity was noted between these different treatment options. On follow-up CT scan and MRI, cysts of types I and II (Galassi classification) exhibited a steady tendency to reduction or obliteration. These results confirm that radical excision of the outer and inner membranes of the cyst wall with fenestration into the basal cistern is a safe and effective shunt-independent procedure for MCFAC, especially for those of types I and II. Received: 28 May 1999 Revised: 10 August 1999