El-Ghandour Nasser M F
Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
J Neurosurg Pediatr. 2012 Mar;9(3):231-8. doi: 10.3171/2011.12.PEDS11298.
Arachnoid cysts located in the middle cranial fossa are common, comprising about half of all intracranial arachnoid cysts. The management of these cysts is challenging, and the optimal surgical treatment is controversial. This study evaluates the role of endoscopy in the treatment of middle cranial fossa arachnoid cysts (MCFACs) in children, focusing on some factors or technical aspects that might influence the outcome.
Thirty-two children with symptomatic MCFACs were the subject of this study. The group included 23 boys and 9 girls, with a mean age of 3.6 years. All patients underwent operations using a purely endoscopic cystocisternostomy procedure through a transtemporal approach.
Significant clinical improvement occurred in 28 cases (87.5%). Postoperative MR imaging showed a reduction in cyst size in 23 cases (71.9%), whereas in the remaining 9 cases (28.1%), the cyst size was unchanged. Minor intraoperative bleeding occurred in 3 cases (9.4%), which stopped spontaneously without any postoperative sequelae. Ipsilateral subdural hygroma occurred in 2 cases (6.3%) and resolved within a few weeks without surgery; transient oculomotor palsy occurred in 1 case (3.1%). During follow-up (mean 4.6 years), 3 patients (9.4%) experienced recurrence of symptoms and an increase in cyst size. Interestingly, all 3 patients who had recurrence had also experienced intraoperative bleeding at initial surgery. At a second endoscopic procedure, the fenestration was found to be closed in all 3 patients.
Endoscopic cystocisternostomy is recommended in the treatment of MCFACs in children because it is simple, minimally invasive, and effective. It maintains the basic strategy of cyst fenestration into the basal cisterns without the invasiveness of open craniotomy. This procedure reduces operative and recovery times and is associated with low morbidity and mortality rates.
位于中颅窝的蛛网膜囊肿很常见，约占所有颅内蛛网膜囊肿的一半。这些囊肿的治疗具有挑战性，最佳手术治疗方法存在争议。本研究评估了内镜在儿童中颅窝蛛网膜囊肿（MCFACs）治疗中的作用，重点关注可能影响治疗结果的一些因素或技术方面。
本研究以32例有症状的MCFACs患儿为研究对象。该组包括23名男孩和9名女孩，平均年龄3.6岁。所有患者均通过经颞入路采用单纯内镜下囊肿脑池造瘘术进行手术。
28例（87.5%）临床症状明显改善。术后磁共振成像显示23例（71.9%）囊肿大小缩小，而其余9例（28.1%）囊肿大小未变。3例（9.4%）术中出现少量出血，自行停止，无任何术后后遗症。2例（6.3%）出现同侧硬膜下积液，数周内未经手术自行消退；1例（3.1%）出现短暂性动眼神经麻痹。在随访期间（平均4.6年），3例患者（9.4%）症状复发且囊肿大小增加。有趣的是，所有3例复发患者在初次手术时也都出现了术中出血。在第二次内镜手术中，发现所有3例患者的造瘘口均已闭合。
内镜下囊肿脑池造瘘术推荐用于儿童MCFACs的治疗，因为它简单、微创且有效。它保持了将囊肿开窗至基底池的基本策略，而没有开颅手术的侵入性。该手术减少了手术时间和恢复时间，且发病率和死亡率较低。
