Naito Nobuaki, Nonaka Masahiro, Miyata Mayuko, Ueno Katsuya, Kamei Takamasa, Asai Akio
Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan.
Surg Neurol Int. 2022 Mar 31;13:112. doi: 10.25259/SNI_99_2022. eCollection 2022.
Although endoscopic ventriculo-cysto-cisternostomy is considered to be effective for suprasellar arachnoid cysts, we encountered a giant suprasellar arachnoid cyst that recurred despite surgery using this technique.
The patient was a 9-month-old boy. Magnetic resonance imaging revealed a huge suprasellar arachnoid cyst extending from the suprasellar region to the anterior skull base and both middle cranial fossa. First, an endoscopic procedure was performed to open the cyst wall between the right ventricle and the cyst and between the cyst and the prepontine cistern. Although the cyst initially shrank, it recurred over the next 2 months, and hence, we performed another endoscopic surgery. At the second surgery, both the previously opened stomas were found to be occluded. To reopen the cyst wall between the ventricle and the cyst, multiple holes were made with monopolar electrodes, and forceps were used to connect the holes by grasping and twisting the cyst wall so that the stoma was much larger than at the previous surgery. Postoperatively, the cyst shrank and the patient's head circumference stopped expanding.
Following the treatment of large cysts, the stoma might become narrower as the cyst shrinks, resulting in obstruction. Using the technique reported here might prevent occlusion of large arachnoid cysts.
尽管内镜下脑室 - 囊肿 - 脑池造瘘术被认为对鞍上蛛网膜囊肿有效，但我们遇到了一例巨大的鞍上蛛网膜囊肿，尽管采用了该技术进行手术，囊肿仍复发。
患者为一名9个月大的男孩。磁共振成像显示一个巨大的鞍上蛛网膜囊肿，从鞍上区域延伸至前颅底和双侧中颅窝。首先，进行了内镜手术，打开右心室与囊肿之间以及囊肿与脑桥前池之间的囊肿壁。尽管囊肿最初缩小，但在接下来的2个月内复发，因此，我们进行了另一次内镜手术。在第二次手术中，发现之前打开的两个造口均已闭塞。为重新打开脑室与囊肿之间的囊肿壁，用单极电极打了多个孔，并用钳子通过抓取和扭转囊肿壁将这些孔连接起来，使造口比前一次手术时大得多。术后，囊肿缩小，患者头围停止增大。
在治疗大囊肿后，随着囊肿缩小，造口可能会变窄，导致阻塞。采用本文报道的技术可能会防止大蛛网膜囊肿的闭塞。
