Schulz Matthias, Kimura Takaoki, Akiyama Osamu, Shimoji Kazuaki, Spors Birgit, Miyajima Masakazu, Thomale Ulrich-Wilhelm
Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
World Neurosurg. 2015 Aug;84(2):327-36. doi: 10.1016/j.wneu.2015.03.026. Epub 2015 Mar 25.
A Sylvian fissure arachnoid cyst (SAC) is a well-recognized location for an intracranial arachnoid cyst in the pediatric population. For those cysts, which can rupture and be accompanied by a subdural hygroma or hematoma, several treatment modalities have been reported. We report clinical and radiological outcome of fenestration of these cysts by either endoscopy or microsurgery.
A retrospective review of the database of operative procedures revealed 24 procedures (20 endoscopic and 4 microsurgical procedures) to fenestrate a SAC at university hospitals in Berlin, Germany and Tokyo, Japan.
With the applied technique, a reduction of SAC volume of more than 10% was achieved in 83.3% of all patients. The median volume of SACs (n = 24) was significantly reduced from 83.5 mL (range 21-509 mL) preoperatively to 45.5 mL (range 8.4-261 mL; P < 0.01) after 3.5 months and to 29.0 mL (range 0-266 mL; P < 0.01) after 15 months. In children (n = 8) with a ruptured SAC the combined extraaxial volume of a SAC and accompanying hygroma/hematoma was reduced from 166 mL (range 111-291 mL) before surgery to 127 mL (range 87-329 mL) after 2 months and to 77 mL (range 25-140 mL; P < 0.05) after 11 months. Acute clinical symptoms were generally resolved postoperatively; headaches were resolved or improved in 75%. A significant association of resolution or improvement of headaches and volume reduction was demonstrated.
The study demonstrated efficacy in a predominantly endoscopically treated patient cohort with Sylvian fissure arachnoid cysts, as indicated by improvement of clinical symptoms and diminished radiological SAC volume after treatment.
大脑外侧裂蛛网膜囊肿（SAC）是儿童颅内蛛网膜囊肿的一个公认部位。对于那些可能破裂并伴有硬膜下积液或血肿的囊肿，已有多种治疗方式的报道。我们报告了通过内镜或显微手术对这些囊肿进行开窗术的临床和影像学结果。
对手术操作数据库进行回顾性分析，发现在德国柏林和日本东京的大学医院中有24例对SAC进行开窗术的手术（20例内镜手术和4例显微手术）。
采用所应用的技术，83.3%的患者SAC体积减少超过10%。24例SAC的中位体积从术前的83.5 mL（范围21 - 509 mL）在3.5个月后显著减少至45.5 mL（范围8.4 - 261 mL；P < 0.01），在15个月后减少至29.0 mL（范围0 - 266 mL；P < 0.01）。在8例SAC破裂的儿童中，SAC与伴发的积液/血肿的联合轴外体积从手术前的166 mL（范围111 - 291 mL）在2个月后减少至127 mL（范围87 - 329 mL），在11个月后减少至77 mL（范围25 - 140 mL；P < 0.05）。急性临床症状通常在术后得到缓解；75%的患者头痛得到缓解或改善。头痛的缓解或改善与体积缩小之间存在显著关联。
该研究表明，在以内镜治疗为主的大脑外侧裂蛛网膜囊肿患者队列中，治疗后临床症状改善和影像学上SAC体积减小，证明了开窗术的有效性。
