内镜辅助下小儿大脑外侧裂蛛网膜囊肿全外壁单纯切除术
Endoscopy-assisted purely total outer wall excision for pediatric Sylvian arachnoid cysts.
作者信息
Wu Mingxing, Di Fei, Ma Mingle, Li Jiye, Li Yanbin, Zhang Bingke
机构信息
Department of Neurosurgery, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
出版信息
Chin Neurosurg J. 2023 Jul 13;9(1):20. doi: 10.1186/s41016-023-00330-7.
BACKGROUND
To present a novel endoscopy-assisted surgical strategy of Sylvian arachnoid cysts (ACs).
CASE PRESENTATION
Endoscopy-assisted surgery was performed on 9 children (May 2019-December 2021). All patients were evaluated with CT and/or MRI and had regular follow-up examinations. The procedure consisted of performing a small temporal craniotomy (2 cm) behind the hairline. After dural opening, the surgery was performed with the assistance of a rigid 30-degree transcranial endoscope, self-irrigating bipolar forceps, and other standard endoscopic instruments. Steps included total excision of the AC outer wall and dissection of arachnoid adhesion around the cystic edge to communicate the residual cyst cavity with subdural space. Compared with the microscopical procedure, a 30-degree transcranial endoscope provides a wider view, especially for the lateral part exposure of the outer wall. The average age of the patients was 27.7 months (range 13-44 months). The Sylvian AC was in the right hemisphere in three patients and six in the left, respectively. 1 patient suffered transient postoperative epilepsy. There was no mortality or additional postoperative neurological deficit in this series. All of the patients achieved significant clinical improvement after surgery. Radiological examination after the operation showed a significant reduction in all cases (100%, 9/9) and disappearance in one case (11.1%, 1/9). Postoperative subdural fluid collection occurred in six cases and completely resolved spontaneously in 9 months.
CONCLUSION
The study demonstrated the minimally invasive, safety, and effectivity of the endoscopy-assisted purely total outer wall excision.
背景
介绍一种新颖的内镜辅助手术治疗大脑外侧裂蛛网膜囊肿（ACs）的策略。
病例报告
对9例儿童患者（2019年5月至2021年12月）实施了内镜辅助手术。所有患者均接受了CT和/或MRI评估，并进行了定期随访检查。手术步骤包括在发际线后方做一个小的颞部开颅手术（2厘米）。打开硬脑膜后，在30度硬质经颅内镜、自冲洗双极电镊和其他标准内镜器械的辅助下进行手术。步骤包括完全切除AC外壁，并分离囊肿边缘周围的蛛网膜粘连，以使残留的囊肿腔与硬脑膜下腔相通。与显微镜手术相比，30度经颅内镜提供了更广阔的视野，特别是在外壁外侧部分的暴露方面。患者的平均年龄为27.7个月（范围13 - 44个月）。大脑外侧裂AC分别位于右侧半球3例，左侧半球6例。1例患者术后出现短暂性癫痫。本系列中无死亡病例或术后额外的神经功能缺损。所有患者术后均取得了显著的临床改善。术后影像学检查显示所有病例均有显著缩小（100%，9/9），1例消失（11.1%，1/9）。6例患者术后出现硬脑膜下积液，9个月内完全自行消退。
结论
该研究证明了内镜辅助完全切除外壁手术的微创性、安全性和有效性。
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