André Arthur, Zérah Michel, Roujeau Thomas, Brunelle Francis, Blauwblomme Thomas, Puget Stéphanie, Bourgeois Marie, Sainte-Rose Christian, Ville Yves, Di Rocco Federico
*Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris, France; ‡Department of Neuroradiology Necker Enfants Malades Hospital, APHP, Paris, France; §Department of Obstetrics Necker Enfants Malades Hospital, APHP, Paris, France.
Neurosurgery. 2016 Mar;78(3):370-9; discussion 379-80. doi: 10.1227/NEU.0000000000001049.
Suprasellar arachnoid cysts (SAC) represent between 9% and 21% of pediatric arachnoid cysts. Recent improvements in magnetic resonance imaging, as well as increasing prenatal diagnosis, have allowed more precise knowledge and follow-up.
To describe a novel classification of SAC.
We present 35 cases of SAC treated between 1996 and 2014. Patient records and imaging studies were reviewed retrospectively to assess symptomatology, radiological findings, treatment, and long-term follow-up.
Fourteen SAC were diagnosed prenatally (39%). We observed 15 (43%) cases presenting hydrocephalus (SAC-1) removing Liliequist membrane downward. Lower forms (SAC-2) with free third ventricle were observed in 11 (31%) cases. Asymmetrical forms (SAC-3) with Sylvian or temporal extension were seen in the 9 (26%) remaining patients. Twenty-three (66%) patients were treated by ventriculocisternostomy, 3 (8.5%) by shunt surgery, and 3 (8.5%) by craniotomy. Six (17%) patients had no surgery, including 5 cases (14%) that had prenatal diagnosis. Outcomes were initially favorable in 26 cases (87%). Eight (22%) patients had endocrine abnormalities at the end of the follow-up, 3 (8.5%) had developmental delay, and 6 (17%) had minor neuropsychological disturbances.
SAC are heterogeneous entities. SAC-1 may come from an expansion of the diencephalic leaf of the Liliequist membrane. SAC-2 show a dilatation of the interpeduncular cistern and correspond to a defect of the mesencephalic leaf of the Liliequist membrane. SAC-3 correspond to the asymmetrical forms expanding to other subarachnoid spaces. Surgical treatment is not always necessary. The recognition of the different subtypes will allow choosing the best treatment option.
鞍上蛛网膜囊肿（SAC）占儿童蛛网膜囊肿的9%至21%。磁共振成像技术的最新进展以及产前诊断的增加，使得人们对其有了更精确的认识和随访。
描述一种新的SAC分类方法。
我们呈现了1996年至2014年间治疗的35例SAC病例。对患者记录和影像学研究进行回顾性分析，以评估症状、影像学表现、治疗方法和长期随访情况。
14例SAC在产前被诊断出来（39%）。我们观察到15例（43%）出现脑积水的病例（SAC-1），其Liliequist膜向下移位。11例（31%）观察到具有自由第三脑室的低位型（SAC-2）。其余9例（26%）患者出现向外侧裂或颞叶延伸的不对称型（SAC-3）。23例（66%）患者接受了脑室腹腔分流术，3例（8.5%）接受了分流手术，3例（8.5%）接受了开颅手术。6例（17%）患者未接受手术，其中5例（14%）为产前诊断病例。26例（87%）患者的初始治疗效果良好。随访结束时，8例（22%）患者出现内分泌异常，3例（8.5%）出现发育迟缓，6例（17%）出现轻微神经心理障碍。
SAC是异质性实体。SAC-1可能源于Liliequist膜间脑叶的扩张；SAC-2表现为脚间池扩张，对应于Liliequist膜中脑叶的缺陷；SAC-3对应于向其他蛛网膜下腔扩展的不对称型。并非总是需要手术治疗。认识不同的亚型将有助于选择最佳的治疗方案。
