Okano Atsushi, Ogiwara Hideki
Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
Childs Nerv Syst. 2016 Jan;32(1):153-8. doi: 10.1007/s00381-015-2908-y. Epub 2015 Sep 30.
Although middle fossa arachnoid cysts (MFACs) are common, the optimal surgical treatment for these lesions remains controversial. In this study, we present our experiences of treating MFACs by microsurgical fenestration and evaluate its effectiveness.
We performed retrospective review of 28 patients who underwent microsurgical fenestration for MFACs between May 2003 and December 2014. We reviewed patient characteristics and treatment outcomes including age, sex, symptoms, complicating hydrocephalus, Gallasi classification, change in cyst size after surgery, complicating subdural hygroma, symptom resolution, regrowth of the cyst, and reoperation (including additional CSF diversion).
Twenty-eight MFACs in 28 patients were investigated. The average age at the time of surgery was 61.6 months. The average follow-up duration was 53.5 months. After surgery, 19 (90.5 %) of 21 patients with symptomatic MFACs experienced improvements. The cysts decreased in size in all cases (100 %, 28/28) and disappeared in three cases (11 %, 3/28). None of the cases experienced regrowth of the cyst. Subdural hygroma was identified in 23 cases (82.1 %) at the immediate postoperative period. Hygroma was asymptomatic in all cases but one. Hygroma disappeared in 19 cases (83 %) and decreased in size in three cases (13 %) in the long term. Only one case (4 %) required an additional subdural-peritoneal shunt. The rate of CSF diversion after the fenestration was significantly higher in patients with preoperative ventricular dilation (p = 0.0002).
Microsurgical fenestration for pediatric MFACs was considered to be safe and effective. Although subdural hygroma developed in significant number of patients at the immediate postoperative period, it was mostly asymptomatic and disappeared or decreased in size in the long term.
尽管中颅窝蛛网膜囊肿（MFACs）很常见，但针对这些病变的最佳手术治疗方法仍存在争议。在本研究中，我们介绍了通过显微手术开窗治疗MFACs的经验并评估其有效性。
我们对2003年5月至2014年12月期间接受显微手术开窗治疗MFACs的28例患者进行了回顾性研究。我们回顾了患者的特征和治疗结果，包括年龄、性别、症状、并发脑积水、加拉西分类、术后囊肿大小变化、并发硬膜下积液、症状缓解情况、囊肿复发以及再次手术（包括额外的脑脊液分流）。
对28例患者的28个MFACs进行了研究。手术时的平均年龄为61.6个月。平均随访时间为53.5个月。术后，21例有症状的MFACs患者中有19例（90.5%）症状改善。所有病例的囊肿大小均减小（100%，28/28），3例（11%，3/28）囊肿消失。无一例囊肿复发。术后即刻有23例（82.1%）发现硬膜下积液。除1例患者外，所有病例的积液均无症状。从长期来看，19例（83%）积液消失，3例（13%）积液大小减小。仅1例（4%）患者需要额外进行硬膜下-腹腔分流。术前脑室扩张的患者开窗术后脑脊液分流率显著更高（p = 0.0002）。
小儿MFACs的显微手术开窗被认为是安全有效的。尽管术后即刻有相当数量的患者出现硬膜下积液，但大多无症状，且从长期来看积液会消失或减小。
