Pediatric Neurosurgery - Department of Neurosurgery, CHRU Montpellier, 80, avenue Augustin Fliche, 34000 Montpellier, France.
Pediatric Neurosurgery - Department of Neurosurgery, CHRU Montpellier, 80, avenue Augustin Fliche, 34000 Montpellier, France.
Neurochirurgie. 2022 Dec;68(6):679-683. doi: 10.1016/j.neuchi.2022.07.004. Epub 2022 Jul 27.
Suprasellar Arachnoid Cysts (SAC) are rare heterogeneous entities. Though prenatally diagnosed, they are rarely treated pre-birth. Symptomatic cases are mainly seen in infants.
We describe a case of a prenatally symptomatic suprasellar arachnoid cyst treated postnatally. The cyst was diagnosed on a routine ultrasound at 22 weeks, was rapidly evolving in the ultrasounds and the MRI of the 29th week. It then became symptomatic at 30 weeks with episodes of fetal bradycardia, independent to the uterine contractions. Antenatal treatment was discussed but delivery decided in emergency despite the prematurity via C-section. Though well tolerated postnatally, the cyst continued to grow. Endoscopic ventriculo-cysto-cisternostomy was performed on the 5th day of birth. Despite progressive reduction of the cyst, residual brainstem compression and evolving ventriculomegaly lead to a transient extrathecal internal shunting.
DISCUSSION/CONCLUSION: Our case suggests that prenatally diagnosed cysts require a close follow-up. Treatment options and timing should be adapted to anatomy, cyst evolution and symptoms whether it is before or after birth.
鞍上蛛网膜囊肿（SAC）是一种罕见的异质性实体。尽管在产前被诊断出来，但它们很少在出生前得到治疗。有症状的病例主要见于婴儿。
我们描述了一例产前有症状的鞍上蛛网膜囊肿，在产后得到治疗。囊肿在 22 周的常规超声检查中被诊断出来，在 29 周的超声和 MRI 中迅速发展。然后在 30 周时出现症状，伴有胎儿心动过缓，与子宫收缩无关。曾讨论过产前治疗，但尽管早产，仍通过剖宫产决定紧急分娩。尽管出生后耐受良好，但囊肿仍继续生长。在出生后第 5 天行内镜脑室-囊肿-池造口术。尽管囊肿逐渐缩小，但脑干受压和不断发展的脑室扩大导致短暂的鞘内外分流。
讨论/结论：我们的病例表明，产前诊断的囊肿需要密切随访。治疗方案和时间应根据解剖结构、囊肿的演变和症状来调整，无论是在出生前还是出生后。
