Gangemi M, Colella G, Magro F, Maiuri F
Department of Neurological Sciences, Unit of Neurosurgery, Federico II University, Naples, Italy.
Br J Neurosurg. 2007 Jun;21(3):276-80. doi: 10.1080/02688690701339197.
The aim of this study is to define the indications to endoscopy versus other surgical procedures in the management of suprasellar arachnoid cysts from a personal series and an extensive literature review. Five symptomatic patients (two children and three adults) with suprasellar arachnoid cysts were treated by endoscopic fenestration in our neurosurgical unit. The endoscopic procedure consisted of ventricle-cyst-cisternostomy in three cases and ventricle-cystostomy in two. Four patients were cured after the endoscopic procedure alone, whereas another with rhinoliquorrhoea later required a craniotomy. The literature review includes 102 patients treated by endoscopic fenestration and 74 treated by other procedures, including microsurgical cyst resection through craniotomy (38 cases), shunt of the cyst (21 cases) and percutaneous ventricle-cystostomy (15 cases). Among the reviewed cases, the rate of cure or improvement was 90% (92 among 102 cases including ours) after endoscopy and 81% (60 among 74 cases) after other surgical procedures. The results of this study suggest that endoscopic ventricle-cyst cisternostomy is the best treatment for suprasellar arachnoid cysts, because it is less invasive, provides the best results and avoids shunt dependency in most cases.
本研究的目的是通过个人病例系列及广泛的文献综述，明确在鞍上蛛网膜囊肿的治疗中，与其他外科手术相比，内镜检查的适应证。我们神经外科单元对5例有症状的鞍上蛛网膜囊肿患者（2例儿童和3例成人）进行了内镜下造瘘治疗。内镜手术包括3例脑室 - 囊肿 - 脑池造瘘术和2例脑室 - 囊肿造瘘术。4例患者仅通过内镜手术后治愈，而另1例出现鼻漏的患者后来需要开颅手术。文献综述纳入了102例行内镜下造瘘治疗的患者和74例行其他手术治疗的患者，其他手术包括开颅显微囊肿切除术（38例）、囊肿分流术（21例）和经皮脑室 - 囊肿造瘘术（15例）。在纳入综述的病例中，内镜检查后的治愈率或改善率为90%（102例中的92例，包括我们的病例），其他外科手术后的治愈率或改善率为81%（74例中的60例）。本研究结果表明，内镜下脑室 - 囊肿脑池造瘘术是鞍上蛛网膜囊肿的最佳治疗方法，因为它侵入性较小，效果最佳，且在大多数情况下可避免依赖分流术。
