Ogiwara Hideki, Morota Nobuhito, Joko Masahiro, Hirota Kengo
Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan.
J Neurosurg Pediatr. 2011 Nov;8(5):484-8. doi: 10.3171/2011.8.PEDS11226.
The endoscopic treatment of a suprasellar arachnoid cyst (SAC) consists mainly of ventriculocystostomy (VC) and ventriculocystocisternostomy (VCC). However, the most appropriate treatment for these cysts has not been fully determined yet. The authors report on the effectiveness of endoscopic VC for SACs communicating with the basal cisterns, which is demonstrated by preoperative CT cisternography.
The authors retrospectively analyzed the surgical results of patients with an SAC treated using endoscopic fenestration. The patient charts were reviewed for demographic data, clinical presentations, surgical therapies, and clinical outcomes.
Six consecutive patients with SAC were surgically treated using endoscopic fenestration (VC or VCC) between March 2004 and February 2011. The mean age was 18.5 months (range 5 days to 37 months). Five patients were previously untreated, and 1 patient had previously undergone ventriculoperitoneal shunt placement. Five patients underwent preoperative CT cisternography, and communication between the SAC and the basal cisterns was demonstrated in 3 patients, very slight communication in 1, and no communication in 1. Four patients, including the 3 with communication between the SAC and basal cisterns, underwent VC. Two patients with very slight or no communication underwent VCC. In all patients the SAC decreased in size and hydrocephalus improved postoperatively. Five patients (3 treated with VC and 2 with VCC [83%]) have been stable without reoperation (mean follow-up 32.7 months). All 3 patients with an SAC communicating with the basal cisterns have been stable without reoperation following VC.
Preoperative cisternography may be useful for selecting the optimal endoscopic treatment method for SAC. If an SAC communicates with the basal cisterns, a VC could be an effective, safe, and simpler treatment option.
鞍上蛛网膜囊肿（SAC）的内镜治疗主要包括脑室囊肿造瘘术（VC）和脑室囊肿脑池造瘘术（VCC）。然而，这些囊肿的最佳治疗方法尚未完全确定。作者报告了术前CT脑池造影显示的内镜下VC治疗与基底池相通的SAC的有效性。
作者回顾性分析了采用内镜开窗术治疗SAC患者的手术结果。查阅患者病历以获取人口统计学数据、临床表现、手术治疗及临床结果。
2004年3月至2011年2月期间，连续6例SAC患者接受了内镜开窗术（VC或VCC）治疗。平均年龄为18.5个月（范围5天至37个月）。5例患者此前未接受过治疗，1例患者曾接受过脑室腹腔分流术。5例患者术前行CT脑池造影，其中3例显示SAC与基底池相通，1例为非常轻微的相通，1例不相通。4例患者，包括3例SAC与基底池相通的患者，接受了VC治疗。2例相通非常轻微或不相通的患者接受了VCC治疗。所有患者术后SAC体积均减小，脑积水得到改善。5例患者（3例接受VC治疗，2例接受VCC治疗[83%]）病情稳定，无需再次手术（平均随访32.7个月）。所有3例SAC与基底池相通的患者在接受VC治疗后病情稳定，无需再次手术。
术前脑池造影可能有助于为SAC选择最佳的内镜治疗方法。如果SAC与基底池相通，VC可能是一种有效、安全且更简单的治疗选择。
