Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
World Neurosurg. 2020 Sep;141:e316-e323. doi: 10.1016/j.wneu.2020.05.122. Epub 2020 May 21.
Suprasellar arachnoid cysts are a rare but important pediatric neurosurgical pathology with unknown ideal management. They have been previously managed with techniques including open craniotomy with microsurgical fenestration, cystoperitoneal shunting, endoscopic ventriculocystostomy, and endoscopic ventriculocystocisternostomy (VCC), without a consistent consensus on the best surgical approach. We present an overview of the literature on surgical management of suprasellar arachnoid cysts.
A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted for all articles evaluating treatment modalities for suprasellar arachnoid cysts, using PubMed, OVID, and Web of Science.
Twenty-five articles on management of suprasellar arachnoid cysts in children were identified. Few published studies exist that examine different types of surgical management across a single institution. The majority of studies reported best clinical outcomes in patients treated with endoscopic approaches when compared with microsurgical fenestration or cystoperitoneal shunting, reporting lower rates of infection, shunt dependence, and need for revision in addition to better resolution of clinical symptoms. Furthermore, most studies argue that VCC is superior to ventriculocystostomy, offering better long-term improvement of clinical symptoms and lower rates of failure.
This study examines the current literature on suprasellar arachnoid cyst surgical management to conclude that an endoscopic approach in comparison with other approaches has the best outcomes. Of the endoscopic options available, VCC provides patients with the best long-term resolution of symptoms and the lowest need for revision. These findings should be further investigated with larger multicenter studies to further compare different surgical techniques and outcomes.
鞍上蛛网膜囊肿是一种罕见但重要的小儿神经外科病理学，其理想的治疗方法尚不清楚。此前，人们采用开颅显微手术开窗、囊肿-腹腔分流、内镜脑室-囊肿造瘘和内镜脑室-脑池造瘘（VCC）等技术对其进行治疗，但对于最佳手术方法尚未达成一致共识。我们对鞍上蛛网膜囊肿的手术治疗文献进行了综述。
按照系统评价和荟萃分析的首选报告项目的指南，对所有评估鞍上蛛网膜囊肿治疗方法的文章进行了文献检索，检索数据库包括 PubMed、OVID 和 Web of Science。
共确定了 25 篇关于儿童鞍上蛛网膜囊肿治疗的文章。很少有发表的研究在单个机构内检查不同类型的手术治疗。与显微手术开窗或囊肿-腹腔分流相比，大多数研究报告内镜治疗的患者具有更好的临床结局，其感染、分流依赖和需要再次手术的发生率更低，同时临床症状的缓解更好。此外，大多数研究认为 VCC 优于脑室-囊肿造瘘，能更好地长期改善临床症状，降低失败率。
本研究对鞍上蛛网膜囊肿手术治疗的现有文献进行了考察，得出结论：与其他方法相比，内镜方法具有最佳的治疗效果。在现有的内镜治疗方法中，VCC 为患者提供了最佳的长期症状缓解和最低的需要再次手术的可能性。这些发现应通过更大规模的多中心研究进一步探讨，以进一步比较不同的手术技术和结果。
