Kim Kyung Hyun, Lee Ji Yeoun, Phi Ji Hoon, Kim Seung-Ki, Cho Byung-Kyu, Wang Kyu-Chang
1Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul.
2Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul; and.
J Neurosurg Pediatr. 2020 May 15;26(3):221-227. doi: 10.3171/2020.3.PEDS19574. Print 2020 Sep 1.
The surgical indications for some arachnoid cysts (ACs) are controversial. While surgical procedures can be effective when an AC is a definite cause of hydrocephalus or papilledema, most ACs do not cause any symptoms or signs. Some surgeons perform several procedures to treat ACs because of their large size. The purpose of this study was to compare the long-term outcomes of Galassi type III ACs between surgery and nonsurgery groups.
The medical records of 60 patients diagnosed with sylvian ACs (Galassi type III) who visited Seoul National University Children's Hospital from July 1990 to March 2018 were analyzed. The authors compared the outcomes between those treated with surgery and those not treated with surgery.
Of the 60 patients, 27 patients had no symptoms, 19 patients had vague symptoms and signs associated with ACs, and the remaining 14 patients had definite AC-related symptoms and signs. Thirty-eight patients underwent surgery, and 22 patients underwent observation. Some operations were accompanied by complications. Among the 33 patients in the surgery group, excluding 5 with hydrocephalus or papilledema, 8 patients needed 18 additional operations. However, there were no patients in the nonsurgery group who needed surgical intervention during the follow-up period (mean 67.5 months), although the size of the AC increased in 2 patients. Changes in AC size were not correlated with symptom relief.
When patients with hydrocephalus or papilledema were excluded, there was no difference in the outcomes between the surgery and nonsurgery groups regardless of the size of the sylvian AC. Surgeons should be cautious when deciding whether to operate.
一些蛛网膜囊肿（ACs）的手术指征存在争议。当AC是脑积水或视乳头水肿的明确病因时，手术治疗可能有效，但大多数ACs不会引起任何症状或体征。一些外科医生因ACs体积大而进行多种手术治疗。本研究的目的是比较手术组和非手术组中Galassi III型ACs的长期预后。
分析了1990年7月至2018年3月期间就诊于首尔国立大学儿童医院的60例被诊断为外侧裂ACs（Galassi III型）患者的病历。作者比较了手术治疗组和未手术治疗组的预后情况。
60例患者中，27例无症状，19例有与ACs相关的模糊症状和体征，其余14例有明确的ACs相关症状和体征。38例患者接受了手术，22例患者接受了观察。一些手术伴有并发症。在手术组的33例患者中，排除5例患有脑积水或视乳头水肿的患者，8例患者需要额外进行18次手术。然而，非手术组在随访期间（平均67.5个月）没有患者需要手术干预，尽管有2例患者的ACs体积增大。ACs大小的变化与症状缓解无关。
排除患有脑积水或视乳头水肿的患者后，无论外侧裂ACs的大小如何，手术组和非手术组的预后没有差异。外科医生在决定是否手术时应谨慎。
