Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, 1095, Wuhan, 430030, Hubei, People's Republic of China.
Childs Nerv Syst. 2021 Apr;37(4):1307-1312. doi: 10.1007/s00381-020-04935-6. Epub 2020 Oct 20.
Surgical fenestration is widely accepted as a primary treatment for middle fossa arachnoid cysts (MFACs) in pediatric patients. However, postoperative subdural effusion and/or hydrocephalus always affect treatment outcomes. In this study, we presented our experience of treating MFACs with surgical fenestration in pediatric patients and analyzed the cases complicated by postoperative subdural effusion and/or hydrocephalus, to give insight into the clinical characteristics predisposing the complications.
We retrospectively analyzed 21 pediatric cases with MFACs treated by surgical fenestration suffering postoperative subdural effusion and/or hydrocephalus in our department from November 2011 to April 2019. We reviewed the clinical characteristics and treatment outcomes.
A total of 21 patients, among a total of 53 pediatric patients with MFACs treated by surgical fenestration, developed subdural effusion and/or hydrocephalus postoperatively. The mean age at the time of the initial surgery was 49 months. A total of 75% (6/8) of the patients under 2 years old and 13.3% (6/45) of the older patient group sustaining postoperative subdural effusion and/or hydrocephalus required further surgeries, respectively (Fisher's exact test, p = 0.001). Notably, among the 21 cases with postoperative subdural effusion and/or hydrocephalus, all the 6 patients under 2 years old needed additional surgeries, while of the other 15 older patients, only 40% (6/15) needed further surgical interventions (Fisher's exact test, p = 0.019).
The immature CSF absorption in MFAC patients younger than 2 years old might predispose them to the relatively serious postoperative subdural effusion and/or hydrocephalus. For very young patients with giant MFACs, surgical fenestration might not be the best option.
对于儿童患者，中颅窝蛛网膜囊肿（MFAC）的手术开窗被广泛认为是一种主要的治疗方法。然而，术后硬膜下积液和/或脑积水总是会影响治疗效果。在这项研究中，我们介绍了我们用手术开窗治疗儿童 MFAC 的经验，并分析了术后并发硬膜下积液和/或脑积水的病例，以深入了解导致这些并发症的临床特征。
我们回顾性分析了 2011 年 11 月至 2019 年 4 月期间我科因手术开窗后并发硬膜下积液和/或脑积水而接受治疗的 21 例儿童 MFAC 病例。我们回顾了这些病例的临床特征和治疗结果。
在总共 53 例因手术开窗治疗的儿童 MFAC 患者中，共有 21 例术后并发硬膜下积液和/或脑积水。初次手术时的平均年龄为 49 个月。2 岁以下的患儿中，75%（6/8）发生术后硬膜下积液和/或脑积水，需要进一步手术治疗，而年龄较大的患儿中，这一比例为 13.3%（6/45）（Fisher 确切检验，p = 0.001）。值得注意的是，在 21 例术后并发硬膜下积液和/或脑积水的患者中，所有 2 岁以下的患儿均需进一步手术治疗，而在其他 15 例年龄较大的患儿中，仅有 40%（6/15）需要进一步手术干预（Fisher 确切检验，p = 0.019）。
2 岁以下儿童的 CSF 吸收不成熟可能导致其术后硬膜下积液和/或脑积水较为严重。对于巨大 MFAC 的非常年幼的患者，手术开窗可能不是最佳选择。
