De Keersmaecker B, Ramaekers P, Claus F, Witters I, Ortibus E, Naulaers G, Van Calenbergh F, De Catte L
Dep of Obstet Gyn, University Hospital Leuven, Leuven, Belgium.
Dep of Obstet Gyn, University Hospital Antwerp, Antwerp, Belgium; Dep of Obstet Gyn, University Hospital Ghent, Ghent, Belgium.
Eur J Paediatr Neurol. 2015 Mar;19(2):114-21. doi: 10.1016/j.ejpn.2014.12.008. Epub 2014 Dec 27.
To investigate the natural history, associated abnormalities and outcome of 12 fetuses with arachnoid cyst diagnosed antenatally by ultrasound and magnetic resonance imaging and to compare the outcome with cases in the literature.
A retrospective study of all cases of antenatally detected fetal arachnoid cysts was performed in patients referred to a tertiary unit between 2007 and 2013. Associated abnormalities, pregnancy outcome and postnatal follow-up were analyzed. All papers about prenatally diagnosed arachnoid cysts, of the last 30 years, were evaluated (search terms in Pubmed: "prenatal diagnosis", "Arachnoid Cysts").
Fetal arachnoid cysts were diagnosed in 12 fetuses, 9 were females. The mean gestational age of diagnosis was 28 1/7 (range 19 1/7-34 2/7 weeks). A total of 9 cases were supratentorial, 3 were located in the posterior fossa. In 10 cases a fetal MRI was performed which confirmed brain compression in 4 out of 5 supratentorial arachnoid cyst. MRI did not reveal other malformations nor signs of nodular heterotopia. Only one fetus presented with additional major anomalies (bilateral ventricumomegaly of >20 mm and rhombencephalosynapsis) leading to a termination of pregnancy. Two neonates underwent endoscopic fenestration of the arachnoid cyst in the first week of life with no additional intervention in childhood. All but one (10/11) had a favorable postnatal outcome. This child suffered from visual impairment at autism was diagnosed at the age of 5. One child had a surgical correction of strabismus later in childhood. In one child the infratentorial arachnoid cyst regressed spontaneously on ultrasound and MRI in the postnatal period.
The majority of arachnoid cysts in this series are of benign origin and remain stable. Based on the current series and the review of the literature, in the absence of other associated anomalies and when the karyotype is normal, the postnatal overall and neurological outcome is favorable. Large suprasellar arachnoid cysts however, may cause visual impairment and endocrinological disturbances. Rarely associated cerebral or cerebellar malformations are present. Modern postnatal management of suprasellar arachnoid cyst consists of endoscopic cystoventriculostomy.
研究12例经超声和磁共振成像产前诊断为蛛网膜囊肿的胎儿的自然病史、相关异常情况及结局，并与文献中的病例结局进行比较。
对2007年至2013年间转诊至三级医疗单位的所有产前检测出胎儿蛛网膜囊肿的病例进行回顾性研究。分析相关异常情况、妊娠结局及产后随访情况。对过去30年所有关于产前诊断蛛网膜囊肿的文献进行评估（在Pubmed中的检索词：“产前诊断”，“蛛网膜囊肿”）。
12例胎儿被诊断为蛛网膜囊肿，9例为女性。诊断时的平均孕周为28又1/7周（范围为19又1/7 - 34又2/7周）。共9例为幕上囊肿，3例位于后颅窝。10例进行了胎儿磁共振成像检查，其中5例幕上蛛网膜囊肿中有4例证实存在脑受压情况。磁共振成像未发现其他畸形或结节性异位的迹象。仅1例胎儿伴有其他主要异常（双侧脑室扩张>20 mm及菱形脑联合），导致终止妊娠。2例新生儿在出生后第一周接受了蛛网膜囊肿内镜开窗术，儿童期未进行其他干预。除1例（10/11）外，所有患儿产后结局良好。该患儿5岁时被诊断患有视力障碍和自闭症。1例患儿在儿童期后期接受了斜视手术矫正。1例患儿后颅窝蛛网膜囊肿在产后经超声和磁共振成像检查发现自行消退。
本系列中大多数蛛网膜囊肿为良性起源且保持稳定。基于本系列研究及文献回顾，在无其他相关异常且核型正常时，产后总体及神经学结局良好。然而，大型鞍上蛛网膜囊肿可能导致视力障碍和内分泌紊乱。罕见相关的脑或小脑畸形。现代鞍上蛛网膜囊肿的产后治疗方法为内镜下囊肿脑室造瘘术。
