Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy.
Neuroradiology Unit, Great Ormond Street Institute of Child Health, London, UK.
Neuroradiology. 2022 Nov;64(11):2163-2177. doi: 10.1007/s00234-022-02990-1. Epub 2022 Jun 7.
To explore the relationships between clinical-radiological features and surgical outcomes in subjects with interhemispheric cysts (IHC) and corpus callosum anomalies.
We reviewed the clinico-radiological and neurosurgical data of 38 patients surgically treated with endoscopic fenestration, shunting, or combined approaches from 2000 to 2018 (24 males, median age 9 years). Pre- and postoperative changes in IHC volume were calculated. Outcome assessment was based on clinico-radiological data. Group comparisons were performed using χ, Fisher exact, Mann-Whitney U, and Kruskal-Wallis tests.
Median age at first surgery was 4 months (mean follow-up 8.3 years). Eighteen individuals (47.3%) required > 1 intervention due to IHC regrowth and/or shunt malfunction. Larger preoperative IHC volume (P = .008) and younger age at surgery (P = .016) were associated with cyst regrowth. At last follow-up, mean cystic volume was 307.8 cm, with IHC volume reduction > 66% in 19/38 (50%) subjects. The neurological outcome was good in 14/38 subjects (36.8%), fair in 18/38 (47.3%), and poor in 6/38 (15.7%). There were no differences in the postoperative cyst volume with respect to either the type of first surgery or overall surgery type. Higher absolute postoperative IHC reduction was observed in subjects who underwent both IHC fenestration and shunting procedures (P < .0001). No differences in neurological outcome were found according to patient age at surgery or degree of IHC reduction.
Endoscopic fenestration and shunting approaches are both effective but often require multiple procedures especially in younger patients. Larger IHC are more frequently complicated by cyst regrowth after surgery.
探讨伴有侧脑室内囊肿（interhemispheric cysts，IHC）和胼胝体异常的患者的临床-影像学特征与手术结果之间的关系。
我们回顾了 2000 年至 2018 年期间采用内镜下开窗、分流或联合方法治疗的 38 例患者的临床-放射学和神经外科数据（24 例男性，中位年龄 9 岁）。计算 IHC 体积的术前和术后变化。根据临床-放射学数据进行结果评估。使用 χ²、Fisher 确切检验、Mann-Whitney U 检验和 Kruskal-Wallis 检验进行组间比较。
首次手术的中位年龄为 4 个月（平均随访 8.3 年）。18 名患者（47.3%）由于 IHC 再生长和/或分流器故障需要进行＞1 次干预。术前 IHC 体积较大（P=0.008）和手术时年龄较小（P=0.016）与囊肿再生长有关。末次随访时，平均囊肿体积为 307.8cm³，38 例中有 19 例（50%）的 IHC 体积减少＞66%。14 例患者（36.8%）的神经功能预后良好，18 例（47.3%）的预后一般，6 例（15.7%）的预后较差。首次手术的类型或总体手术类型均与术后囊肿体积无差异。同时行 IHC 开窗和分流术的患者术后 IHC 体积减少绝对值更大（P＜0.0001）。手术时患者年龄或 IHC 减少程度与神经功能预后无差异。
内镜下开窗和分流方法均有效，但在年轻患者中往往需要多次手术。较大的 IHC 术后更常出现囊肿再生长。
