Guo Huachao, Ma Zhen, Lv Qiang, Li Tao, Dong Liujian, Yu Jinliang, Feng Shubin, Wang Yushe
Department of Neurosurgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital , Zhengzhou, China.
Graduate School of Henan University, Zhengzhou, China.
Front Pediatr. 2025 Feb 20;13:1518422. doi: 10.3389/fped.2025.1518422. eCollection 2025.
A middle cranial fossa is a well-recognized location for an intracranial arachnoid cyst in children. Giant middle fossa arachnoid cysts (GMFACs) can compress brain tissue, leading to rupture and potentially developing a subdural hygroma or hematoma. With recent advancements in neuroendoscopic technology, neuroendoscopic treatments have increasingly been used for middle fossa cysts. However, the risk of subdural effusion or hematoma is higher postoperatively, and the treatment for subdural effusion remains inconclusive. This study aimed to explore the safety and efficacy of this technology by evaluating the clinical and radiological outcomes of endoscopic fenestration for these cysts.
A retrospective review of the operative procedures database identified 26 procedures performed to fenestrate GMFACs at the Neurosurgery Department of Henan Provincial Children's Hospital. The minimum follow-up period exceeded 6 months.
A total of 26 patients were included between 2016 and 2021. Among the 26 patients, 19 were male, with a mean age of 3.56 ± 2.98 years; 13 were under 2 years. With the applied technique, the cyst volume reduction rate was 76.9% ( = 20). A reduction of more than 50% in middle fossa arachnoid cyst volume was achieved in 57.7% of all patients ( = 15). In five cases (19.2%), the cyst had disappeared by the follow-up date, or its volume reduction exceeded 90%. Symptom improvement or resolution was observed in 13 of the 15 patients (86.7%). The postoperative subdural effusion rate was 53.8% ( = 14). Among these, 64.2% (9/14) of the children experienced complete absorption of subdural effusion, with a mean duration of 5.38 ± 5.37 months. Only 21.4% (3/14) of the children had subdural effusion requiring further surgery. The overall patient reoperation rate was 11.5% (3/26). The multivariate logistic regression analysis results showed that age under 2 years was not associated with postoperative subdural effusion ( = 0.119) or the need for reoperation ( = 0.786).
This study analyzed the efficacy of endoscopic treatment in a predominantly treated patient cohort with GMFACs, as indicated by improved clinical symptoms and reduced radiological volume after treatment. Furthermore, This study has shown that age is neither the cause of subdural effusion nor the leading cause of secondary surgery. Most subdural effusions in children can be absorbed within a few months after surgery, and only a few children need subsequent surgical treatment. Endoscopy is a safe technique for managing giant middle fossa cysts, including younger children.
中颅窝是儿童颅内蛛网膜囊肿公认的好发部位。巨大中颅窝蛛网膜囊肿（GMFACs）可压迫脑组织，导致破裂并可能发展为硬膜下积液或血肿。随着神经内镜技术的最新进展，神经内镜治疗越来越多地用于中颅窝囊肿。然而，术后硬膜下积液或血肿的风险较高，且硬膜下积液的治疗仍无定论。本研究旨在通过评估这些囊肿内镜开窗术的临床和影像学结果，探讨该技术的安全性和有效性。
对手术操作数据库进行回顾性分析，确定了河南省儿童医院神经外科为26例GMFACs患者实施开窗术的病例。最短随访期超过6个月。
2016年至2021年间共纳入26例患者。26例患者中，男性19例，平均年龄3.56±2.98岁；13例年龄在2岁以下。采用该技术后，囊肿体积缩小率为76.9%（n=20）。所有患者中有57.7%（n=15）的中颅窝蛛网膜囊肿体积缩小超过50%。5例（19.2%）患者在随访时囊肿消失，或其体积缩小超过90%。15例患者中有13例（86.7%）症状改善或消失。术后硬膜下积液发生率为53.8%（n=14）。其中，64.2%（9/14）的患儿硬膜下积液完全吸收，平均持续时间为5.38±5.37个月。只有21.4%（3/14）的患儿硬膜下积液需要进一步手术治疗。总体患者再次手术率为11.5%（3/26）。多因素logistic回归分析结果显示，2岁以下年龄与术后硬膜下积液（P=0.119）或再次手术需求（P=0.786）无关。
本研究分析了内镜治疗在以GMFACs为主的治疗患者队列中的疗效，治疗后临床症状改善和影像学体积减小表明了这一点。此外，本研究表明年龄既不是硬膜下积液的原因，也不是二次手术的主要原因。大多数儿童硬膜下积液在术后几个月内可吸收，只有少数儿童需要后续手术治疗。神经内镜是治疗巨大中颅窝囊肿（包括年幼儿童）的一种安全技术。
