Sinurat Robert
Surgery Department, Medical Faculty of Universitas Kristen, Indonesia.
Int J Surg Case Rep. 2022 May;94:107101. doi: 10.1016/j.ijscr.2022.107101. Epub 2022 Apr 20.
Arachnoid cyst in the middle fossa can cause many symptoms include headache and seizure. When drugs therapy can not relieve or control the symptoms, it is necessary to determine whether the surgical procedure can improve patient's outcome.
First case, 28 years old female suffered from severe headache and sometimes unconsciousness for a few minutes. Magnetic resonance images showed the lesion hypo-intense on T1-weight and hyper-intense on T2-weight images. Left M1 middle cerebral artery lay down inside the cyst. The second case, a man 18 years old had seizures every three months. He took phenytoin 600 mg a day but in the last one month seizures repeated up to five times. The brain MRI results showed a hypointense lesion of T1-weight and hyperintense at T2-weight in the right temporal region measuring approximately 5 × 4 cm and compressing the temporal bone to form a convex shape. The third case, a man 23 years old had complaints of seizures since 6 months. The patient received the drug phenytoin 3x200mg and valproic acid 1 g daily but the seizures still exist. The brain MRI showed hyperintense lesion in the right temporal region. Microscopic fenestration craniotomy was performed in all cases and at one year of follow-up the headache disappeared. Seizure attacks have never occurred again with only low doses of phenytoin.
The result of microscopic fenestration craniotomy in patients with headaches and seizures due to middle fossa arachnoid cysts is good and can be considered for controlling seizures in selected cases.
中颅窝蛛网膜囊肿可引起多种症状，包括头痛和癫痫发作。当药物治疗无法缓解或控制症状时，有必要确定手术是否能改善患者的预后。
第一个病例，一名28岁女性，患有严重头痛，有时会昏迷几分钟。磁共振成像显示病变在T1加权像上呈低信号，在T2加权像上呈高信号。左侧大脑中动脉M1段位于囊肿内。第二个病例，一名18岁男性，每三个月发作一次癫痫。他每天服用600毫克苯妥英钠，但在过去一个月里癫痫发作多达五次。脑部MRI结果显示右侧颞区有一个T1加权像低信号、T2加权像高信号的病变，大小约为5×4厘米，压迫颞骨形成凸形。第三个病例，一名23岁男性，6个月来一直有癫痫发作的症状。患者每天服用3×200毫克苯妥英钠和1克丙戊酸，但癫痫仍有发作。脑部MRI显示右侧颞区有高信号病变。所有病例均进行了显微镜下开窗颅骨切除术，随访一年时头痛消失。仅服用低剂量苯妥英钠后癫痫发作再也没有发生过。
显微镜下开窗颅骨切除术治疗中颅窝蛛网膜囊肿所致头痛和癫痫的效果良好，在某些病例中可考虑用于控制癫痫发作。
