Cinalli Giuseppe, Spennato Pietro, Columbano Laura, Ruggiero Claudio, Aliberti Ferdinando, Trischitta Vincenzo, Buonocore Maria Consiglio, Cianciulli Emilio
Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
J Neurosurg Pediatr. 2010 Nov;6(5):489-97. doi: 10.3171/2010.8.PEDS08491.
In this paper, the authors' goal was to evaluate the role of neuroendoscopy in the treatment of arachnoid cysts of the quadrigeminal cistern.
Between March 1995 and February 2008, 14 patients affected by arachnoid cysts of the quadrigeminal cistern were treated endoscopically. The cysts were classified according to their anatomical and radiological appearance. The most frequent form (Type I) extended infratentorially and supratentorially with a dumbbell shape. Type II cysts were confined to the infratentorial space and were associated with the most severe and acute form of hydrocephalus. Type III cysts presented a significant asymmetric expansion toward the temporal fossa. Ten patients underwent an endoscopic procedure as primary treatment and 4 as an alternative to shunt revision. In 6 cases, the first endoscopic procedure was ventriculocystostomy (VC) together with endoscopic third ventriculostomy (ETV). In the other 8 cases, the first endoscopic procedure was VC alone.
In the 6 cases in which VC was performed with an ETV, the procedure was successful, and the patients did not require further surgery. Of the 8 cases in which the first endoscopic procedure performed was VC without ETV, 7 underwent reoperation. Four of these patients underwent endoscopic procedures (by reopening the obstructed VC and performing ETV or cystocisternostomy) 2, 4, 4, and 5 months later with final success in all cases. Three patients (all of whom were previously treated using ventriculo- or cystoperitoneal shunts) required shunt reimplantation (complete failure). Subdural collection developed in 1 case, which was managed by transient insertion of a subduroperitoneal shunt. Neurological and developmental outcomes were good except for 1 patient who did not show improvement in preoperative developmental delay. No transient or permanent morbidity or mortality was observed.
The analysis of this series suggests that arachnoid cysts of the quadrigeminal cistern and the associated hydrocephalus can be effectively treated by endoscopy; this approach allows the patient to be shunt independent in more than 78% of the cases. If endoscopy is used as first option, the success rate of endoscopic procedures observed in this series was 90%. Endoscopic third ventriculostomy should be associated with a VC to offer the highest success rate with a single procedure.
在本文中，作者的目标是评估神经内镜在治疗四叠体池蛛网膜囊肿中的作用。
1995年3月至2008年2月期间，对14例四叠体池蛛网膜囊肿患者进行了内镜治疗。根据囊肿的解剖和影像学表现进行分类。最常见的类型（I型）呈哑铃形，幕下和幕上均有延伸。II型囊肿局限于幕下空间，与最严重和急性的脑积水形式相关。III型囊肿向颞窝有明显的不对称扩张。10例患者接受内镜手术作为主要治疗，4例作为分流修正术的替代方法。6例患者首次内镜手术为脑室囊肿造瘘术（VC）联合内镜下第三脑室造瘘术（ETV）。其他8例患者首次内镜手术仅为VC。
在6例进行VC联合ETV的患者中，手术成功，患者无需进一步手术。在首次内镜手术仅为VC而未进行ETV的8例患者中，7例接受了再次手术。其中4例患者分别在2、4、4和5个月后接受了内镜手术（通过重新打开阻塞的VC并进行ETV或囊肿脑池造瘘术），所有病例最终均成功。3例患者（均曾接受脑室或囊肿腹腔分流术治疗）需要重新植入分流管（完全失败）。1例发生硬膜下积液，通过临时插入硬膜下腹腔分流管进行处理。除1例术前发育迟缓未改善的患者外，神经和发育结局良好。未观察到短暂或永久性的并发症或死亡。
该系列分析表明，四叠体池蛛网膜囊肿及相关脑积水可通过内镜有效治疗；这种方法使超过78%的患者无需分流。如果将内镜作为首选方法，本系列中观察到的内镜手术成功率为90%。内镜下第三脑室造瘘术应与VC联合使用，以提供单次手术的最高成功率。
