Hinojosa J, Esparza J, Muñoz M J, Valencia J
Servicio de Neurocirugía Pediátrica, Hospital Universitario 12 de Octubre, Madrid.
Neurocirugia (Astur). 2001 Dec;12(6):482-8; discussion 489. doi: 10.1016/s1130-1473(01)70662-8.
Arachnoid cysts account for only 1% of all intracranial space-occupying lesions. In adults suprasellar cysts represent 9% of all the arachnoid cysts while in pediatric population this percentage reaches 15%. In spite of being a problem relatively common in daily neurosurgical practice there are still a number of questions to be solved concerning pathogenesis and evolution, natural history and treatment. Located in the suprasellar cistern and closely related to the ventricular system, suprasellar arachnoid cysts conform a perfect indication for endoscopic treatment. The development and spreading of neuroendoscopic techniques have surpassed the standard microsurgical approaches as an elective treatment. However there is still controversy on the management of associated hydrocephalus, need for cystoperitoneal shunt after endoscopic fenestration or the superiority of ventriculocystocisternostomy over simple ventriculocystostomy. The authors present a serie of seven consecutive patients with "de novo" diagnosis of suprasellar arachnoid cyst. In every case the treatment consisted in endoscopic fenestration and removal of the cyst membranes, with or without associated ventriculostomy of the IIIrd ventricle. Preoperative symptoms improved in all the patients and five out of seven remain shunt free. One patient maintains a cystoperitoneal shunt and another one, previously shunted, remains shunt dependent. The clinical presentation and postoperative evolution are commented with discussion on the alternative therapeutic options from the endoscopic point of view.
蛛网膜囊肿仅占所有颅内占位性病变的1%。在成人中，鞍上囊肿占所有蛛网膜囊肿的9%，而在儿童人群中，这一比例达到15%。尽管在日常神经外科实践中这是一个相对常见的问题，但关于其发病机制、演变、自然史和治疗仍有许多问题有待解决。鞍上蛛网膜囊肿位于鞍上池，与脑室系统密切相关，是内镜治疗的理想适应证。神经内镜技术的发展和普及已使其超越标准显微手术方法成为一种选择性治疗手段。然而，对于相关脑积水的处理、内镜开窗术后是否需要囊肿 - 腹腔分流术，以及脑室 - 囊肿 - 脑池造瘘术相对于单纯脑室 - 囊肿造瘘术的优越性仍存在争议。作者报告了连续7例初诊为鞍上蛛网膜囊肿的患者。每例患者的治疗均包括内镜开窗及囊肿膜切除，部分患者同时行第三脑室造瘘术。所有患者术前症状均有改善，7例中有5例无需分流。1例患者保留囊肿 - 腹腔分流，另1例既往已行分流术，仍依赖分流。本文将对临床表现及术后演变进行阐述，并从内镜角度对其他治疗选择进行讨论。
