Greenfield Jeffrey P, Souweidane Mark M
Department of Neurological Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Neurosurg Focus. 2005 Dec 15;19(6):E7. doi: 10.3171/foc.2005.19.6.8.
Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used. This review was conducted to assess what variables influence the treatment success for different categories of arachnoid cysts.
Thirty-three consecutive patients who underwent endoscopic fenestration for treatment of an intracranial arachnoid cyst were identified from a prospective database. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Specific examples of each cyst category are included to illustrate the technical aspects of endoscopic cyst fenestration. Endoscopic fenestration of arachnoid cysts was successful when judged by cyst decompression, and symptom resolution was noted in 32 (97%) of 33 cases. The one patient with short-term treatment failure underwent a successful repetition of the operation. There were no surgery-related morbidities or deaths.
Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid-containing cisterns. Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensity combine to make this a safe procedure with excellent outcomes.
内镜下开窗术已被公认为有症状蛛网膜囊肿患者可接受的治疗选择。然而，该手术的成功率受囊肿的个体解剖结构、位置以及所采用的内镜技术的极大影响。本综述旨在评估哪些变量会影响不同类型蛛网膜囊肿的治疗成功率。
从一个前瞻性数据库中确定了33例连续接受内镜下开窗术治疗颅内蛛网膜囊肿的患者。回顾了手术指征和技术，并评估了手术成功率和患者预后。每个囊肿类型都包含具体实例，以说明内镜下囊肿开窗术的技术要点。经囊肿减压判断，蛛网膜囊肿内镜下开窗术成功，33例中有32例（97%）症状得到缓解。1例短期治疗失败的患者再次手术成功。无手术相关的并发症或死亡。
蛛网膜囊肿是一种相对良性的病理实体，可通过在内镜引导下对囊肿壁进行开窗，使其与脑室系统或含脑脊液的脑池相通来治疗。恰当的患者选择、术前内镜路径规划、无框架导航的使用以及内镜镜头技术和光强的进步，共同使该手术成为一种安全且效果极佳的手术。
