Martínez-Lage Juan F, Valentí José A, Piqueras Claudio, Ruiz-Espejo Antonio M, Román Francisco, Nuño de la Rosa Juan A
Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, E-30120, Murcia, Spain.
Childs Nerv Syst. 2006 Sep;22(9):1091-7. doi: 10.1007/s00381-006-0043-5. Epub 2006 Feb 22.
Many arachnoid cysts (AC) are detected incidentally in asymptomatic patients. Current neuroimaging methods provide only morphological details of the cysts, but they do not give information about cerebral function. While surgery is indicated in symptomatic patients, the management of asymptomatic individuals, who present with large cysts, is controversial.
To ascertain the value of cerebral 99 mTc-HMPAO single photon emission computed tomography (SPECT) for detecting brain dysfunction in cases of intracranial ACs, aimed at allocating the patients for surgical or for conservative treatment.
We studied prospectively 11 patients diagnosed with sylvian fissure ACs. The subjects underwent neurological examination, EEG, neuroimaging studies, neuropsychological testing, and cerebral perfusion studies with 99 mTc-HMPAO SPECT.
The patients' ages ranged from 2 to 42 years (median 16 years). The study group consisted of ten symptomatic patients with ACs and one patient with an incidental cyst. Seven patients showed diminished regional cerebral blood flow (rCBF) in their initial cerebral SPECT. Four individuals underwent surgery. Seven patients showed normalization of rCBF after surgical or conservative treatment.
Cerebral SPECT demonstrated impaired brain perfusion in 70% of symptomatic patients. The zone of decreased rCBF corresponded well with clinical symptoms and with neuroimaging findings. Patients exhibiting normal rCBF in SPECT studies remained or became asymptomatic during the follow-up time. Cerebral SPECT constitutes a valuable adjunct tool for correlating regional function with brain anatomy, and may be of help to allocate patients with ACs for surgical treatment or clinical observation. Further research on this field is warranted.
许多蛛网膜囊肿（AC）是在无症状患者中偶然发现的。目前的神经影像学方法仅提供囊肿的形态学细节，但无法提供有关脑功能的信息。虽然有症状的患者需要手术治疗，但对于无症状且囊肿较大的患者的治疗仍存在争议。
确定脑99mTc-HMPAO单光子发射计算机断层扫描（SPECT）在检测颅内AC患者脑功能障碍方面的价值，旨在为患者分配手术或保守治疗方案。
我们前瞻性地研究了11例被诊断为外侧裂AC的患者。受试者接受了神经学检查、脑电图、神经影像学研究、神经心理学测试以及99mTc-HMPAO SPECT脑灌注研究。
患者年龄范围为2至42岁（中位数16岁）。研究组包括10例有症状的AC患者和1例偶然发现囊肿的患者。7例患者在初次脑SPECT检查中显示局部脑血流量（rCBF）减少。4例患者接受了手术。7例患者在手术或保守治疗后rCBF恢复正常。
脑SPECT显示70%有症状的患者脑灌注受损。rCBF降低的区域与临床症状和神经影像学结果高度相符。在SPECT研究中显示rCBF正常的患者在随访期间保持无症状或症状消失。脑SPECT是将区域功能与脑解剖结构相关联的有价值的辅助工具，可能有助于为AC患者分配手术治疗或临床观察方案。该领域值得进一步研究。
