Yang Seung-Ho, Lee Kwan-Sung, Sung Jae Hoon, Son Byung Chul, Jeun Sin-Soo, Kang Joon-Ki
Department of Neurosurgery, St. Vincent's Hospital, Catholic University of Korea, Suwon, Korea.
Pediatr Neurosurg. 2008;44(6):465-70. doi: 10.1159/000172969. Epub 2008 Nov 17.
There has been much debate about the optimal surgical management of arachnoid cysts in infants younger than 1 year of age. The authors present the clinical and neuroimaging findings in pediatric patients with supratentorial arachnoid cysts treated by surgical decompression.
A retrospective chart review was conducted to identify all pediatric patients who had been diagnosed with arachnoid cysts since 2003. Five infants with symptomatic supratentorial arachnoid cysts underwent surgery at Kangnam St. Mary's Hospital.
The initial surgery in 4 patients involved a craniotomy with the excision of the cyst wall and fenestration into the basal cisterns. Three of the four patients needed additional procedures, such as cyst-peritoneal or subdural-peritoneal shunting due to failure of cyst resolution. A shunting procedure was performed as initial therapy in 1 patient who presented with increased intracranial pressure.
Our strategy for approaching arachnoid cysts in pediatric patients has been to diagnose and treat the cysts as early as possible and to avoid the complications of shunts whenever possible. However, open craniotomy with excision and fenestration of the cyst is associated with a relatively high failure rate in pediatric patients younger than 1 year of age with supratentorial arachnoid cysts.
对于1岁以下婴儿蛛网膜囊肿的最佳手术治疗方法一直存在很多争议。作者介绍了经手术减压治疗的幕上蛛网膜囊肿儿科患者的临床和神经影像学表现。
进行回顾性病历审查，以确定自2003年以来所有被诊断为蛛网膜囊肿的儿科患者。5例有症状的幕上蛛网膜囊肿婴儿在江南圣母医院接受了手术。
4例患者的初次手术包括开颅切除囊肿壁并向基底池造瘘。这4例患者中有3例由于囊肿未消退而需要额外的手术，如囊肿-腹腔或硬膜下-腹腔分流术。1例出现颅内压升高的患者以分流术作为初始治疗。
我们处理儿科患者蛛网膜囊肿的策略是尽早诊断和治疗囊肿，并尽可能避免分流术的并发症。然而，对于1岁以下幕上蛛网膜囊肿的儿科患者，开颅切除囊肿并造瘘的失败率相对较高。
