Cinalli Giuseppe, Peretta Paola, Spennato Pietro, Savarese Luciano, Varone Antonio, Vedova Paola, Grimaldi Gianpina, Ragazzi Paola, Ruggiero Claudio, Cianciulli Emilio, Maggi Giuseppe
Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
J Neurosurg. 2006 Sep;105(3 Suppl):194-202. doi: 10.3171/ped.2006.105.3.194.
Interhemispheric arachnoid cysts are very rare, and they are often associated with complex brain malformations such as corpus callosum agenesis and hydrocephalus. Debate remains concerning the proper management of these lesions. Placement of shunts and microsurgical marsupialization of the cyst are the traditional options. Using endoscopic methods to create areas of communication between the cyst, the ventricular system, and/or the subarachnoid space is an attractive alternative to the use of shunts and microsurgery.
Between 2000 and 2005, seven consecutive pediatric patients with interhemispheric arachnoid cysts underwent neuroendoscopic treatment involving cystoventriculostomy in two patients, cystocisternostomy in two, and cystoventriculocisternostomy in three. There were three cases of associated hydrocephalus, six cases of corpus callosum agenesis, and one case of corpus callosum hypogenesis. The follow-up period ranged from 12 to 49 months (mean 31.6 months). Endoscopic procedures were completely successful in all but two patients. In one of the remaining two patients, a repeated endoscopic cystocisternostomy was performed with success because of closure of the previous stoma. In the other, a subcutaneous collection of cerebrospinal fluid (CSF) was managed by insertion of an lumboperitoneal shunt. A subdural collection of CSF developed in three patients; it was treated with insertion of a subduroperitoneal shunt in one patient and managed conservatively in the other two patients, resolving spontaneously without further treatment. Neurodevelopmental evaluation performed in six patients showed normal intelligence (total intelligence quotient [IQ] > 80) in three patients, mild developmental delay (total IQ 50-80) in two, and severe developmental delay (total IQ < 50) in one.
Endoscopic treatment of interhemispheric cysts can be considered a useful alternative to traditional treatments, even if some complications are to be expected, such as subdural or subcutaneous CSF collections and CSF leaks due to thinness of cerebral mantle and to the often-associated multifactorial hydrocephalus.
大脑半球间蛛网膜囊肿非常罕见，且常与复杂的脑畸形相关，如胼胝体发育不全和脑积水。对于这些病变的恰当治疗仍存在争议。传统的治疗选择包括放置分流管和囊肿显微造袋术。使用内镜方法在囊肿、脑室系统和/或蛛网膜下腔之间建立交通区域是一种有吸引力的替代分流管和显微手术的方法。
2000年至2005年期间，7例连续的患有大脑半球间蛛网膜囊肿的儿科患者接受了神经内镜治疗，其中2例行囊肿脑室造瘘术，2例行囊肿脑池造瘘术，3例行囊肿脑室脑池造瘘术。伴有脑积水3例，胼胝体发育不全6例，胼胝体发育不良1例。随访时间为12至49个月（平均31.6个月）。除2例患者外，内镜手术全部成功。其余2例患者中，1例因先前造口闭合而再次行内镜囊肿脑池造瘘术并成功；另1例通过插入腰大池腹腔分流管处理皮下脑脊液积聚。3例患者出现硬膜下脑脊液积聚；1例患者通过插入硬膜下腹腔分流管治疗，另外2例保守处理，未经进一步治疗自行消退。对6例患者进行的神经发育评估显示，3例患者智力正常（总智商[IQ]>80），2例轻度发育迟缓（总IQ 50 - 80），1例严重发育迟缓（总IQ<50）。
大脑半球间囊肿的内镜治疗可被视为传统治疗的一种有用替代方法，即使可能会出现一些并发症，如硬膜下或皮下脑脊液积聚以及由于脑皮质薄和常伴发的多因素脑积水导致的脑脊液漏。
