Beresford Charles, Hall Samuel, Smedley Alexander, Mathad Nijaguna, Waters Ryan, Chakraborty Aabir, Sparrow Owen C, Tsitouras Vassilios
Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
Childs Nerv Syst. 2020 Apr;36(4):729-741. doi: 10.1007/s00381-019-04477-6. Epub 2020 Jan 2.
Primary cysts are believed to arise from the splitting of the arachnoid membrane during prenatal development and can be diagnosed in utero. Prenatal diagnosis is uncommon; therefore, the evidence base for counselling expectant mothers is limited. The purpose of this article is to present a case series and review the current literature on prenatally diagnosed arachnoid cysts.
A keyword search of hospital electronic records was performed for all patients with a prenatally diagnosed arachnoid cyst at a tertiary neurosurgical centre. Case notes were reviewed for all patients diagnosed between 2005 and 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to structure a systematic review of all English language articles published up to May 2018.
A total of eight eligible patients were identified from our own records and 123 from the literature. Sixty-eight per cent of patients had a normal outcome. Sixty-three per cent of patients underwent surgical intervention which was not associated with abnormal outcome. The diagnosis of syndromic/genetic diagnosis (p < 0.001) and the presence of other intra-cranial anatomical abnormalities (p = 0.05) were significant predictors of abnormal outcome.
The pathogenesis and prognosis of a prenatal arachnoid cyst diagnosis remain unclear. These results suggest favourable outcomes from simple cysts without associated abnormalities and expectant mothers should be counselled accordingly. A wider prospective review is required to better established evidence-based practice.
原发性囊肿被认为是在产前发育过程中蛛网膜分裂形成的，可在子宫内诊断出来。产前诊断并不常见；因此，为孕妇提供咨询的证据基础有限。本文的目的是呈现一个病例系列，并综述目前关于产前诊断蛛网膜囊肿的文献。
在一家三级神经外科中心，对所有产前诊断为蛛网膜囊肿的患者进行医院电子记录的关键词搜索。对2005年至2017年间确诊的所有患者的病例记录进行了回顾。使用系统评价和Meta分析的首选报告项目（PRISMA）指南对截至2018年5月发表的所有英文文章进行系统综述。
从我们自己的记录中总共确定了8例符合条件的患者，从文献中确定了123例。68%的患者预后正常。63%的患者接受了手术干预，且手术干预与异常预后无关。综合征/基因诊断（p < 0.001）和其他颅内解剖异常的存在（p = 0.05）是异常预后的重要预测因素。
产前蛛网膜囊肿诊断的发病机制和预后仍不清楚。这些结果表明，无相关异常的单纯囊肿预后良好，应据此为孕妇提供咨询。需要进行更广泛的前瞻性综述，以更好地确立循证实践。
