Srinivasan Uddanapalli Sreeramulu, Lawrence Radhi
Department of Neurosurgery, MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India.
Department of Pathology MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India.
Asian J Neurosurg. 2015 Jan-Mar;10(1):47. doi: 10.4103/1793-5482.151512.
The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.
We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973-2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.
In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.
We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.
成人后颅窝蛛网膜囊肿（PFAC）的治疗存在争议。回顾我们的病例及相关文献，提出一种切实可行的手术策略，以期在PFAC的治疗中获得优异的长期疗效。
我们分析了12年间收治的26例成人大型颅内蛛网膜囊肿的病例记录。其中，有7例为有症状的PFAC患者。回顾了1973年至2012年间174例PFAC病例的文献，并纳入了我们新的7例病例，随访时间为3至12年。
6例PFAC位于中线。第7例位于脑桥小脑（CP）角外侧。所有患者均接受了手术治疗。其中5例进行了囊肿切除。在两个第四脑室内囊肿病例中，均进行了囊肿-腹腔分流术。术后计算机断层扫描/磁共振成像显示囊肿大小有不同程度减小，尽管所有患者临床症状均有改善。我们提出了一种针对这些病例的手术策略，这将有助于外科医生进行决策。
我们观察到这些PFAC可发生于第四脑室内或斜坡后区域的中线部位，或第四脑室以外区域。也可发生于CP角外侧、小脑后方或为小脑内囊肿。其重要性在于，除了中线第四脑室内囊肿/斜坡后囊肿外，其余囊肿均可安全切除并获得优异的长期疗效。中线第四脑室内囊肿/斜坡后囊肿的治疗策略可以是囊肿-腹腔分流术或囊肿内镜开窗术。
