Zivkovic Bojana, Micovic Mirko, Bascarevic Vladimir, Savic Andrija, Rasulic Lukas
Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia.
Neurosurg Rev. 2018 Apr;41(2):683-688. doi: 10.1007/s10143-018-0954-0. Epub 2018 Feb 21.
The most common location for intracranial arachnoid cysts is the region of the Sylvian fissure, where they can be found in 49% of cases. Management of these cysts is still quite controversial. We present our surgical technique for the treatment of large Sylvian fissure arachnoid cysts which involves cyst decompression and simultaneous calvarial remodeling. After decreasing cyst size, remodeling of the frontal, temporal, and parietal bones follows. The cyst itself is treated with a cystoperitoneal shunt. In immediate postoperative period, correction of the deformity is observed. The cyst volume is reduced immediately after surgery, and adequate adaptation of the bone is achieved. Our surgical procedure for simultaneous bone remodeling and cyst decompression is a fast, simple, and effective treatment option for patients with large Sylvian fissure arachnoid cysts associated with significant cranial disfigurement. We consider cranial remodeling in case of large arachnoid cyst important not just because of the cosmetic result but also for reducing remaining intracranial space filled with cerebrospinal fluid. It may be an important factor to reduce the risk of intracystic and subdural hemorrhage. It is a widely applicable procedure that does not require special tools and expensive equipment, and yet it can help avoid multiple surgeries and complications tied to them.
颅内蛛网膜囊肿最常见的位置是大脑外侧裂区域，49%的病例可在此处发现囊肿。这些囊肿的治疗仍颇具争议。我们介绍了治疗大脑外侧裂大型蛛网膜囊肿的手术技术，该技术包括囊肿减压和同期颅骨重塑。在减小囊肿大小后，接着对额骨、颞骨和顶骨进行重塑。囊肿本身采用囊肿 - 腹腔分流术治疗。术后即刻可观察到畸形得到矫正。术后囊肿体积立即减小，骨结构实现了充分的适应性改变。我们同时进行骨重塑和囊肿减压的手术方法，对于伴有明显颅骨畸形的大脑外侧裂大型蛛网膜囊肿患者而言，是一种快速、简单且有效的治疗选择。我们认为，对于大型蛛网膜囊肿进行颅骨重塑不仅是因为美观效果，还在于减少充满脑脊液的剩余颅内空间。这可能是降低囊内和硬膜下出血风险的一个重要因素。这是一种广泛适用的手术方法，不需要特殊工具和昂贵设备，而且有助于避免多次手术及其相关并发症。
