Nowosławska Emilia, Polis Lech, Kaniewska Danuta, Mikołajczyk Wanda, Krawczyk Jacek, Szymański Wojciech, Zakrzewski Krzysztof, Podciechowska Joanna
Neurol Neurochir Pol. 2003 May-Jun;37(3):587-600.
The aim of the study was to evaluate the use of neuroendoscopic techniques (in comparison with other surgical procedures) in the treatment for arachnoid cysts in children. The analysis was performed on results of treatment 22 children with arachnoid cysts submitted to neuroendoscopic procedures. The group consisted of 6 girls and 16 boys, aged from 1 day to 18 years (mean age 5.3 years, SD +/- 5.6). The control group treated with other, non-endoscopic surgical procedures consisted of 61 patients (20 girls and 41 boys aged from 10 days to 17 years, mean age 7 years, SD +/- 6). Criteria of success varied according to the type of surgical treatment. In the case of procedures other than shunt implantation, the treatment was regarded as effective, if there was no need to change the surgical method, while shunt implantation was considered effective, if shunt revision was not necessary. The operative treatment outcome was assessed using the Glasgow Outcome Scale. Post-treatment changes in the clinical state were graded as improvement, no change, or deterioration. In terms of the assumed criteria of success in the treatment for arachnoid cysts, neuroendoscopic procedures and microsurgical cyst excisions were among the most effective methods. As many as 90.9% of neuroendoscopically treated children needed no other operation, in comparison with 92.6% of patients submitted to microsurgical procedures, who needed no change in the operative treatment. In the group of neuroendoscopically treated patients the effectiveness of neuroendoscopic operations varied according to the type of procedure used. Cystocysternostomies or cystoventriculostomies were successful in 100%. The analysis of clinical outcome has shown that deterioration was observed only in 13% of the patients with shunt implantation. Analyzing each type of arachnoid cyst separately, a statistically significant relationship was found between improvement of the clinical state and the use of craniotomy in the surgical treatment for cysts localized in the posterior fossa. Improvement in the case of neuroendoscopically treated children was related to a larger reduction in the cyst size after surgery and to a lower intensity of intraoperative bleeding. Neuroendoscopic techniques allowed to reduce the average period of hospitalization. Neuroendoscopic cystocysternostomy and cystoventriculostomy were the most effective techniques, besides microsurgical excision of arachnoid cysts. Neuroendoscopic treatment efficacy depends on the type of procedure used. The application of neuroendoscopic techniques allows to reduce the period of hospitalization.
本研究的目的是评估神经内镜技术（与其他外科手术方法相比）在儿童蛛网膜囊肿治疗中的应用。对22例接受神经内镜手术的蛛网膜囊肿患儿的治疗结果进行了分析。该组包括6名女孩和16名男孩，年龄从1天至18岁（平均年龄5.3岁，标准差±5.6）。接受其他非内镜手术治疗的对照组由61例患者组成（20名女孩和41名男孩，年龄从10天至17岁，平均年龄7岁，标准差±6）。成功标准根据手术治疗类型而异。对于分流植入以外的手术，如果无需改变手术方法，则治疗被视为有效；而对于分流植入，如果无需进行分流修正，则认为是有效的。采用格拉斯哥预后量表评估手术治疗结果。将治疗后临床状态的变化分为改善、无变化或恶化。就蛛网膜囊肿治疗的假定成功标准而言，神经内镜手术和显微手术囊肿切除术是最有效的方法之一。多达90.9%接受神经内镜治疗的儿童无需进行其他手术，相比之下，接受显微手术的患者中有92.6%无需改变手术治疗。在接受神经内镜治疗的患者组中，神经内镜手术的有效性因所采用的手术类型而异。囊肿-脑池造瘘术或囊肿-脑室造瘘术的成功率为100%。临床结果分析表明，仅13%接受分流植入的患者出现病情恶化。分别分析每种类型的蛛网膜囊肿时，发现对于位于后颅窝的囊肿，临床状态的改善与手术治疗中使用开颅手术之间存在统计学显著关系。接受神经内镜治疗的儿童病情改善与术后囊肿大小的更大程度缩小以及术中出血强度较低有关。神经内镜技术能够缩短平均住院时间。除了蛛网膜囊肿的显微手术切除外，神经内镜囊肿-脑池造瘘术和囊肿-脑室造瘘术是最有效的技术。神经内镜治疗效果取决于所采用的手术类型。神经内镜技术的应用能够缩短住院时间。
