Couvreur Tim, Hallaert Giorgio, Van Der Heggen Tatjana, Baert Edward, Dewaele Frank, Kalala Okito Jean-Pierre, Vanhauwaert Dimitri, Deruytter Marc, Van Roost Dirk, Caemaert Jacques
Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium; Department of Neurosurgery, AZ Delta, Roeselare, Belgium.
Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium.
World Neurosurg. 2015 Sep;84(3):734-40. doi: 10.1016/j.wneu.2015.04.053. Epub 2015 May 9.
Arachnoid cysts are lesions present in 1% of the population and usually found in the temporal fossa. Clinical and radiologic presentations can differ greatly. Despite intensive research, it is still debatable which patients will benefit from surgery.
This study aims to investigate the pretreatment parameters influencing the outcome after neuroendoscopic treatment of temporal arachnoid cysts.
A retrospective analysis of 34 patients who underwent an endoscopic fenestration of a temporal arachnoid cyst between July 1991 and December 2013 was performed.
In symptomatic patients, there was a clinical improvement in 76.4% of cases. The best results were found in treating symptoms related to intracranial hypertension, acute neurologic defects, and macrocrania. Patients with temporal lobe epilepsy improved after cyst fenestration in 33.3% of cases. Behavioral problems and psychomotor retardation remained largely unchanged. Patients with a complex neurologic presentation, often from a congenital syndrome and combined with an intellectual disability, had the least benefit from endoscopic surgery. Radiologic follow-up showed a cyst volume decrease in 91.2% of cases. Complications were present in 29.4%, but were mostly minor and transient.
This study demonstrates that patients with symptoms related to intracranial hypertension, acute neurologic deficits, and macrocrania have the best postoperative outcome. Also, patients with ipsilateral temporal lobe epilepsy seem to be good candidates for endoscopic arachnoid cyst fenestrations. In complex neurologic disorders without one of the previously mentioned symptoms, endoscopy remains less successful.
蛛网膜囊肿在人群中的发病率为1%，通常位于颞窝。其临床和影像学表现差异很大。尽管进行了深入研究，但哪些患者能从手术中获益仍存在争议。
本研究旨在探讨影响颞叶蛛网膜囊肿神经内镜治疗术后效果的术前参数。
对1991年7月至2013年12月间接受颞叶蛛网膜囊肿内镜开窗术的34例患者进行回顾性分析。
有症状的患者中，76.4%的病例临床症状得到改善。治疗与颅内高压、急性神经功能缺损和巨头症相关的症状效果最佳。颞叶癫痫患者囊肿开窗术后33.3%的病例病情改善。行为问题和精神运动发育迟缓基本未变。具有复杂神经表现、通常源于先天性综合征并伴有智力障碍的患者从内镜手术中获益最少。影像学随访显示91.2%的病例囊肿体积减小。并发症发生率为29.4%，但大多轻微且短暂。
本研究表明，与颅内高压、急性神经功能缺损和巨头症相关症状的患者术后效果最佳。此外，同侧颞叶癫痫患者似乎是内镜下蛛网膜囊肿开窗术的良好候选者。对于没有上述症状之一的复杂神经疾病，内镜治疗的成功率仍然较低。
