El-Ghandour Nasser M F
Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
J Neurosurg Pediatr. 2011 Jul;8(1):6-14. doi: 10.3171/2011.4.PEDS1184.
Suprasellar arachnoid cysts (SACs) are rare, comprising approximately 10% of all intracranial arachnoid cysts. Although neuroendoscopic management is emerging as a safe effective alternative to microsurgery, the type of endoscopic surgery whether ventriculocystostomy (VC) or ventriculocystocisternostomy (VCC) is still controversial. This study evaluates the role of endoscopy in the treatment of SACs in children. It compares VC and VCC to determine which procedure is superior in the long term.
Twenty-five children (14 boys and 11 girls; mean age 26 months) with symptomatic SACs associated with hydrocephalus are the subject of this study. According to the surgical procedure adopted, patients were divided into 2 groups. Patients in Group A (11 patients) underwent VC with a mean follow-up of 55 months, and those in Group B (14 patients) underwent VCC with a mean follow-up of 64.7 months.
Both procedures proved to be effective clinically and radiologically. The incidence of improvement of hydrocephalus-related symptoms was 63.6% in Group A compared with 85.7% in Group B. Improvement in cyst size and hydrocephalus after VC was 81.8% and 63.6%, respectively, compared with 100% and 85.7%, respectively, after VCC. There were no deaths or permanent morbidity, and no patient was left with a permanent shunt. Recurrence occurred in 3 cases after VC (27.3%), whereas no recurrence (0%) was encountered after VCC. At a second endoscopic procedure, the fenestration was found to be closed in all 3 recurrent cases.
An endoscopic procedure is recommended in the treatment of SACs in children because it is simple, effective, minimally invasive, and associated with low morbidity and mortality rates. Both procedures, VC and VCC, proved to be almost equally effective clinically and radiologically. Nevertheless, because of the statistically significant difference between the incidence of recurrence after VC and VCC during long-term follow-up, the author concludes that VCC should be considered as the procedure of choice in the treatment of these cases. The important finding of reclosure of the VC fenestration in the recurrent cases underscores the significance of performing cystocisternostomy at initial surgery to guard against cyst recurrence.
鞍上蛛网膜囊肿（SACs）较为罕见，约占所有颅内蛛网膜囊肿的10%。尽管神经内镜治疗正逐渐成为显微手术的一种安全有效的替代方法，但内镜手术的类型，无论是脑室囊肿造瘘术（VC）还是脑室囊肿脑池造瘘术（VCC），仍存在争议。本研究评估了内镜在儿童鞍上蛛网膜囊肿治疗中的作用。比较了VC和VCC，以确定从长期来看哪种手术更优。
本研究的对象为25例有症状的鞍上蛛网膜囊肿合并脑积水的儿童（14例男孩和11例女孩；平均年龄26个月）。根据所采用的手术方式，将患者分为2组。A组（11例患者）接受了VC，平均随访55个月；B组（14例患者）接受了VCC，平均随访64.7个月。
两种手术在临床和影像学上均被证明是有效的。A组脑积水相关症状改善的发生率为63.6%，而B组为85.7%。VC术后囊肿大小和脑积水的改善率分别为81.8%和63.6%，而VCC术后分别为100%和85.7%。没有死亡或永久性并发症，也没有患者留置永久性分流装置。VC术后有3例复发（27.3%），而VCC术后未出现复发（0%）。在第二次内镜手术时，发现所有3例复发病例的造瘘口均已闭合。
建议采用内镜手术治疗儿童鞍上蛛网膜囊肿，因为它简单、有效、微创，且发病率和死亡率低。VC和VCC这两种手术在临床和影像学上几乎同样有效。然而，由于长期随访中VC和VCC术后复发率存在统计学上的显著差异，作者得出结论，VCC应被视为这些病例治疗的首选手术方式。复发病例中VC造瘘口重新闭合这一重要发现强调了在初次手术时进行囊肿脑池造瘘以防止囊肿复发的重要性。
