Cristobal Ricardo, Oghalai John S
Otology, Neurotology, and Skull Base Surgery, Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Curr Opin Otolaryngol Head Neck Surg. 2007 Oct;15(5):323-9. doi: 10.1097/MOO.0b013e328270b8c5.
The present review summarizes the current theories on arachnoid cyst formation, the common presentations of cysts surrounding or eroding the temporal bone from the middle and posterior cranial fossae, the diagnostic strategies and the management considerations and options.
Arachnoid cysts are most common in the middle cranial fossa and rarely present in association with the petrous apex. They are frequently found incidentally on imaging studies performed in the workup for unrelated symptoms. When they do cause symptoms, these are usually nonspecific. Thus it is important to establish the relationship between the two. Peripetrosal arachnoid cysts may cause cranial nerve deficits in addition to symptoms related to intracranial hypertension. Small asymptomatic cysts are managed conservatively with serial imaging. Large symptomatic cysts are often managed surgically with shunting, open excision or open or neuroendoscopic fenestration or marsupialization. The management of large asymptomatic cysts depends on the patient and cyst characteristics.
Peripetrosal arachnoid cysts are often incidental findings. Careful selection of surgical candidates is of utmost importance. Multiple surgical options with similar success rates are available. The rates and profile of their complications may differ. Overall, approximately 70% of patients experience improvement in their symptoms with surgery.
本综述总结了目前关于蛛网膜囊肿形成的理论、中颅窝和后颅窝围绕或侵蚀颞骨的囊肿的常见表现、诊断策略以及治疗考量和选择。
蛛网膜囊肿最常见于中颅窝，很少与岩尖相关。它们经常在针对无关症状进行的影像学检查中偶然发现。当它们确实引起症状时，通常是非特异性的。因此，确定两者之间的关系很重要。岩周蛛网膜囊肿除了引起与颅内高压相关的症状外，还可能导致颅神经功能缺损。小型无症状囊肿通过定期影像学检查进行保守治疗。大型有症状囊肿通常通过分流、开放切除、开放或神经内镜开窗或袋形缝合术进行手术治疗。大型无症状囊肿的治疗取决于患者和囊肿特征。
岩周蛛网膜囊肿常为偶然发现。仔细选择手术候选者至关重要。有多种成功率相似的手术选择。其并发症的发生率和情况可能不同。总体而言，约70%的患者术后症状有所改善。
