Takeshige Nobuyuki, Eto Tomoko, Nakashima Shinji, Sakata Kiyohiko, Uchikado Hisaaki, Abe Toshi, Morioka Motohiro
Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
Department of Radiology, Kurume University School of Medicine, Kurume, Japan.
Surg Neurol Int. 2018 Mar 7;9:57. doi: 10.4103/sni.sni_245_17. eCollection 2018.
Intracranial arachnoid cysts are space-occupying lesions that typically remain stable or decrease in size over time. Cysts in infants younger than 1 year of age are remarkably different from those in older children and adults in terms of cyst localization and enlargement. Arachnoid cysts of the posterior fossa (PFACs) are very rare in infants and do not typically grow or present with clinical symptoms, such that surgical treatment is generally considered to be unnecessary. Here, we describe an extremely rare case of an infant with a rapidly enlarging symptomatic PFAC that was successfully treated with surgery.
A 4-month-old boy presented with increasing head circumference and a rapidly enlarging arachnoid cyst in the left posterior fossa with ventriculomegaly, which was documented using serial imaging over the preceding 2 months. We performed a microscopic resection of the cyst membrane to remove the mass effect as soon as possible and facilitate normal development. To confirm dural closure and prevent cerebrospinal fluid leakage, we also performed short-term (7 days) percutaneous long-tunneled external ventricle drainage after the surgery. Magnetic resonance imaging over a 4-year follow-up period revealed adequate reduction of the ventricle and cyst. The patient no longer exhibited progressive macrocrania and showed normal development.
To our knowledge, this is the second successful case of surgical treatment of an enlarging symptomatic PFAC in an infant. Our surgical strategy for the treatment of this rare case can serve as a guide for surgeons in similar future cases.
颅内蛛网膜囊肿是占位性病变，通常会随时间保持稳定或缩小。1岁以下婴儿的囊肿在囊肿定位和增大方面与大龄儿童及成人的囊肿有显著差异。后颅窝蛛网膜囊肿（PFACs）在婴儿中非常罕见，通常不会生长或出现临床症状，因此一般认为无需手术治疗。在此，我们描述了一例极为罕见的婴儿病例，其患有快速增大的有症状PFAC，并通过手术成功治疗。
一名4个月大的男孩出现头围增大，左后颅窝有一个快速增大的蛛网膜囊肿并伴有脑室扩大，在过去2个月通过系列影像学检查得以记录。我们尽快进行了囊肿膜的显微切除以消除占位效应并促进正常发育。为确认硬脑膜闭合并防止脑脊液漏，术后我们还进行了短期（7天）经皮长隧道外脑室引流。4年随访期的磁共振成像显示脑室和囊肿充分缩小。该患者不再表现出进行性巨头症，且发育正常。
据我们所知，这是第二例成功手术治疗婴儿增大的有症状PFAC的病例。我们针对此罕见病例的手术策略可为未来类似病例的外科医生提供指导。
