Caldarelli M, Di Rocco C
Institute of Neurosurgery, Catholic University Medical School, Rome, Italy.
Surg Neurol. 1996 Sep;46(3):212-21. doi: 10.1016/0090-3019(96)00155-3.
Arachnoid cysts located within the interhemispheric fissure are a matter of discussion as to the surgical indication and the choice of the most appropriate surgical procedure. In fact, in spite of the large dimensions that they can reach, the clinical manifestations may remain subtle and apparently stable over the years. On the other hand, the larger utilization of prenatal ultrasound investigations has increased the number of lesions detected before they can provoke clinical manifestations. As far as surgery is concerned, two main options are available-an extrathecal shunting procedure or a direct approach to the lesion, with excision of its wall.
In this report, we analyze the results obtained in 25 children harboring an interhemispheric arachnoid cyst, surgically treated in the period 1978 to 1994. Mean age at diagnosis was 18.8 months (10 days to 15 years). RESULTS The main clinical manifestations included macrocrania, mild to moderate signs of increased intracranial pressure, cranial bulging, developmental delay, and neurologic signs. In 14 cases, the diagnosis had been obtained prenatally. The cyst was located in one hemicranium in 16 cases, whereas it was on the midline, with bilateral extension, in the remaining 9 cases; in the latter cases, variable degrees of callosal agenesis were also observed. All 25 children were operated on. In 16 of them, the treatment consisted of a craniotomy with wide excision of the cyst lining and marsupialization into the subarachnoid spaces of the midline (and/or into the ventricular system). In 6 children, the surgical procedure was a cystoperitoneal (CP) shunt. The last 3 children of our series underwent craniotomy and cyst excision after having been treated by means of a ventriculoperitoneal shunt. At follow-up examination, 17 children are normal, and the remaining 8 disclose mild to moderate psychomotor retardation.
Although both craniotomy and CP shunt are associated with good results, the first surgical procedure offers the advantage of avoiding the insertion of a permanent cerebrospinal fluid shunt device and the known complications of this type of procedure.
位于大脑半球间裂的蛛网膜囊肿在手术指征及最合适手术方式的选择上存在争议。事实上，尽管它们可能长得很大，但临床表现可能多年来一直不明显且看似稳定。另一方面，产前超声检查的广泛应用增加了在病变引发临床表现之前被检测到的数量。就手术而言，有两种主要选择——鞘外分流术或直接处理病变并切除其囊壁。
在本报告中，我们分析了1978年至1994年间接受手术治疗的25例患有大脑半球间蛛网膜囊肿的儿童的结果。诊断时的平均年龄为18.8个月（10天至15岁）。结果主要临床表现包括巨头症、轻至中度颅内压升高体征、颅骨膨隆、发育迟缓及神经体征。14例在产前确诊。囊肿位于一侧颅骨的有16例，而其余9例位于中线且双侧延伸；在后一组病例中，还观察到不同程度的胼胝体发育不全。所有25例儿童均接受了手术。其中16例的治疗包括开颅手术，广泛切除囊肿内衬并将其敞开至中线的蛛网膜下腔（和/或脑室系统）。6例儿童接受了囊肿 - 腹腔（CP）分流术。本系列最后3例儿童在接受脑室 - 腹腔分流术后接受了开颅囊肿切除术。随访检查时，17例儿童正常，其余8例有轻至中度精神运动发育迟缓。
尽管开颅手术和CP分流术都有良好效果，但第一种手术方式具有避免插入永久性脑脊液分流装置及此类手术已知并发症的优势。
