Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Childs Nerv Syst. 2024 Dec;40(12):4047-4054. doi: 10.1007/s00381-024-06581-8. Epub 2024 Aug 29.
Arachnoid cysts are commonly encountered benign cystic structures and often come to attention as incidental findings following cranial imaging. Surgical intervention rates vary in different studies; however, rupture of cyst and subdural collection with mass effect are some of the indications for surgical intervention. In this study, we aimed to evaluate our operated cohort of middle fossa arachnoid cysts to determine the rate of traumatic subdural collection in this cohort and further assess outcomes.
A retrospective review of all consecutive operated middle cranial fossa arachnoid cysts was carried out for the period 2010 to 2024. Demographics including age, sex, Galassi type, surgical technique for fenestration, preceding history of trauma, presence of papilloedema, and complications following surgery were extracted. Indication for surgery included papilloedema and headaches or increasing head circumference or rupture and subdural collections. Arachnoid cysts managed with CSF diversion as primary surgery were excluded.
Over the study period, 21 fenestrations of the arachnoid cysts were carried out in 19 patients with mean age of 7 years and M:F ratio of 2.2:1 (laterality: 9 right-sided and 10 left-sided). These included seven Galassi 2 and twelve Galassi 3 arachnoid cysts. At presentation, 10 had papilloedema, 5 with no papilloedema, and 4 with no available ophthalmological assessment. Fenestration of cyst included 12 microscopic, 6 endoscopic, and 3 combined approaches. Of the operated cohort, 8 were due to rupture of arachnoid cyst and subdural collections causing mass effect. Of 8 cases of ruptured arachnoid cyst with subdural collections, 75% had clear history of preceding head injury in the context of accidental or sports-related injuries. Two patients required redo-fenestration (10.5%), 1 patient required temporary lumbar drain (5.2%), and 2 patients required cysto-peritoneal shunts (10.5%).
Rupture of arachnoid cysts and subdural collections although rare can be associated with head injury in majority of cases. All operated cases belonged to grade 2 and 3 Galassi.
蛛网膜囊肿是常见的良性囊性结构，通常在头颅成像后作为偶然发现。不同研究中的手术干预率有所不同；然而，囊肿破裂和伴有占位效应的硬脑膜下积液是手术干预的一些指征。在这项研究中，我们旨在评估我们的中颅窝蛛网膜囊肿手术队列，以确定该队列中创伤性硬脑膜下积液的发生率，并进一步评估结果。
对 2010 年至 2024 年期间所有连续接受手术治疗的中颅窝蛛网膜囊肿患者进行回顾性分析。提取的人口统计学数据包括年龄、性别、Galassi 分型、蛛网膜囊肿开窗术的手术技术、创伤前史、视乳头水肿的存在以及术后并发症。手术指征包括视乳头水肿和头痛或头围增大或囊肿破裂和硬脑膜下积液。作为初次手术的蛛网膜囊肿脑脊液分流术被排除在外。
在研究期间，对 19 例患者的 21 例蛛网膜囊肿进行了开窗术，平均年龄为 7 岁，男女比例为 2.2:1（侧别：9 例右侧，10 例左侧）。其中包括 7 例 Galassi 2 型和 12 例 Galassi 3 型蛛网膜囊肿。在就诊时，10 例有视乳头水肿，5 例无视乳头水肿，4 例无眼科评估。囊肿开窗术包括 12 例显微镜下、6 例内镜下和 3 例联合方法。在手术组中，有 8 例是由于蛛网膜囊肿破裂和伴有占位效应的硬脑膜下积液引起的。在 8 例伴有硬脑膜下积液的蛛网膜囊肿破裂中，75%的患者有明确的头部外伤史，这些外伤是意外或运动相关损伤所致。2 例患者需要再次开窗术（10.5%），1 例患者需要临时腰椎引流（5.2%），2 例患者需要蛛网膜囊肿腹腔分流术（10.5%）。
蛛网膜囊肿破裂和硬脑膜下积液虽然罕见，但在大多数情况下可与头部外伤有关。所有接受手术的病例均属于 Galassi 2 级和 3 级。
