Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, South Fourth Ring West Road 119, Fengtai District, Beijing, 100067, People's Republic of China.
Beijing Neurosurgical Institute, Beijing, People's Republic of China.
Neurosurg Rev. 2020 Oct;43(5):1373-1381. doi: 10.1007/s10143-019-01152-x. Epub 2019 Sep 6.
To investigate the effectiveness of endoscopic fenestration in the patients with prior failed ventriculoperitoneal (VP) shunt treatment of suprasellar arachnoid cysts (SACs). Between 2012 and 2018, four pediatric patients of SACs with previous failed VP shunt treatment were surgically treated using endoscopic ventriculocystocisternostomy (VCC) in our hospital. The clinical symptoms, imaging data, and surgical outcomes were collected and analyzed retrospectively. A literature review is provided with regard to the reasons of shunt failure and surgical outcome of further endoscopic fenestration in the previously reported patients of SACs with prior failed VP shunt. For the 4 cases, the initial clinical symptoms relieved or even disappeared after shunt placement, but, respectively, recurred 2, 6, 11, and 6 months later. MR scans were conducted when the clinical symptoms reappeared and showed a cyst had greatly enlarged after shunt placement. Furthermore, VP shunt-related slit ventricle was also demonstrated in 3 cases. Clinical improvement and cysts shrinkage occurred in all 4 patients after VCC. Slit ventricle and hydrocephalus were also resolved. Three patients had their shunt apparatus removed after VCC, and another patient's guardian refused to remove the shunt apparatus. Subdural hematoma occurred in one case after shunt apparatus removal. Four patients have been stable during follow-up period (mean follow-up 26.5 months). All the three patients whose VP shunt were removed were shunt independence. There were 24 patients who underwent endoscopic fenestration as an alternative to the failed VP shunt treatment in the published reports. Added our 4 patients to the published group, the effective rate of endoscopic fenestration for SACs following previous failed VP shunt treatment was approximately 93% (26/28). Of the 24 patients, the shunt apparatuses were in situ or reimplantation in 9 patients due to shunt dependence. The correction to recognize the SAC is the first condition to select the optimal management philosophy. The analysis of the series suggests endoscopic operation is still an effective and safe option in the SAC patients with previous failed VP shunt, and the shunt apparatus can be removed for some patients. The short interval time between shunt operation and endoscopic fenestration is conductive to return patients to the shunt-free state.
为了研究内镜下开窗术治疗先前失败的脑室-腹腔（VP）分流术治疗鞍上蛛网膜囊肿（SAC）患者的效果。2012 年至 2018 年，我院对 4 例先前 VP 分流术治疗失败的 SAC 患儿采用内镜下脑室-囊肿-脑池造瘘术（VCC）进行手术治疗。回顾性收集并分析了这些患者的临床症状、影像学资料和手术结果。对先前报道的 4 例 SAC 患者进行了内镜下开窗术治疗失败的原因和进一步内镜下开窗术治疗效果的文献复习。对于这 4 例患者，分流术后初始临床症状缓解甚至消失，但分别在 2、6、11 和 6 个月后再次出现。当临床症状再次出现时进行磁共振扫描显示分流术后囊肿明显增大，此外，在 3 例患者中还显示出与 VP 分流相关的裂脑室。所有 4 例患者在 VCC 后均出现临床改善和囊肿缩小。裂脑室和脑积水也得到解决。VCC 后，3 例患者移除了分流装置，另 1 例患者的监护人拒绝移除分流装置。1 例患者在移除分流装置后出现硬膜下血肿。4 例患者在随访期间病情稳定（平均随访 26.5 个月）。在已发表的报道中，有 28 例患者接受了内镜下开窗术作为先前失败的 VP 分流术治疗的替代方法。将我们的 4 例患者加入已发表的研究组，内镜下开窗术治疗先前失败的 VP 分流术治疗的 SAC 患者的有效率约为 93%（26/28）。在这 24 例患者中，由于分流依赖性，9 例患者的分流装置原位或重新植入。认识到 SAC 是选择最佳管理理念的首要条件。对这些病例的分析表明，内镜手术仍然是先前失败的 VP 分流术治疗的 SAC 患者的有效且安全的选择，并且一些患者可以移除分流装置。分流术与内镜下开窗术之间的时间间隔较短有助于患者恢复到无分流状态。
