Nisson Peyton L, Quintero-Consuegra Migeul D, Lekovic Gregory P
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Neurosurgery, House Institute, Los Angeles, California, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
World Neurosurg. 2024 Feb;182:e675-e691. doi: 10.1016/j.wneu.2023.12.018. Epub 2023 Dec 8.
The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory recommendations in the literature, which is limited to mostly case reports. We aimed to provide a comprehensive summary and analysis of symptoms, operative techniques, outcomes, and recurrence of all available surgical cases of AC of the CPA to date.
A systematic literature search was performed in May 2022 querying several scientific databases. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgical procedures were performed.
A total of 55 patients from the literature and 5 treated at our institution were included. Mean patient age was 29 years (range, 0.08-79 years), with nearly twice (1.7×) as many female as male patients (37 female, 22 male). Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of patients with hearing loss, 44% reported a return to normal. The rate of mortality was 1.69%, and 10% of tumors recurred (mean follow-up 2.3 years [range, 0-15 years].
Symptomatic AC of the CPA is rare. It exhibits a proclivity for females and commonly manifests with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for patients with severe symptoms, surgical decompression is an effective tool for symptom alleviation and recovery.
桥小脑角（CPA）蛛网膜囊肿（AC）的手术治疗作用尚不确定。该主题在文献中一直存在争议，有各种相互矛盾的建议，且大多限于病例报告。我们旨在对迄今为止所有可用的CPA区AC手术病例的症状、手术技术、结果和复发情况进行全面总结和分析。
2022年5月进行了系统的文献检索，查询了多个科学数据库。纳入标准规定了所有关于位于CPA区AC患者的研究和病例报告，且这些患者均接受了任何相关手术。
共纳入了文献中的55例患者以及在我们机构治疗的5例患者。患者平均年龄为29岁（范围0.08 - 79岁），女性患者数量几乎是男性患者的两倍（1.7倍）（37例女性，22例男性）。头痛（35%）、听力损失（30%）、眩晕（22%）和共济失调（22%）是最常见的表现。手术后，95%的患者症状改善，64%的患者症状完全缓解。在听力损失患者中，44%报告听力恢复正常。死亡率为1.69%，10%的肿瘤复发（平均随访2.3年[范围0 - 15年]）。
CPA区有症状的AC很少见。它在女性中更常见，通常表现为头痛、听力损失、眩晕和共济失调。虽然需要仔细选择手术适应症，且干预应仅针对症状严重的患者，但手术减压是缓解症状和促进恢复的有效手段。
