Arai H, Sato K, Wachi A, Okuda O, Takeda N
Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Neurosurgery. 1996 Dec;39(6):1108-12; discussion 1112-3. doi: 10.1097/00006123-199612000-00007.
Our surgical results of middle fossa arachnoid cysts are presented, and advantages and disadvantages of cystoperitoneal shunting are discussed.
Seventy-seven patients with middle fossa arachnoid cysts, including 20 cases of asymptomatic cyst, were treated by cystoperitoneal shunting. In cases associated with subdural hematoma, the cystoperitoneal shunt was preceded by irrigation of the hematoma. Follow-up periods ranged from 8 months to 16 years (mean, 7.7 yr).
In all cases, postoperative computed tomography and magnetic resonance imaging revealed subsequent expansion of the surrounding brain, concomitant with either the disappearance of or a marked decrease in the size of the cyst. Patients who initially presented with headaches, hemiparesis, choked discs, and diplopia were cured postoperatively. Head enlargement presented preoperatively did not progress after shunting. Mental retardation and behavior problems, however, remained unchanged postoperatively, even though the cyst had disappeared. One cystoperitoneal shunt became infected, and shunt malfunction developed in eight patients. Four of the eight patients presented acute signs and symptoms of intracranial hypertension when the shunt malfunctioned, although the concurrent increase in cyst size was slight and ventriculomegaly was not seen. The observed condition in these four patients could be considered shunt dependency.
Cystoperitoneal shunting is a valid method of achieving obliteration of the cyst and clinical improvement and seems to feature low operative risk and few complications. It should be noted, however, that some patients experience shunt dependency after cystoperitoneal shunting.
介绍我们关于中颅窝蛛网膜囊肿的手术结果，并讨论囊肿-腹腔分流术的优缺点。
77例中颅窝蛛网膜囊肿患者，包括20例无症状囊肿患者，接受了囊肿-腹腔分流术治疗。对于合并硬膜下血肿的病例，在进行囊肿-腹腔分流术前先对血肿进行冲洗。随访时间为8个月至16年（平均7.7年）。
所有病例术后计算机断层扫描和磁共振成像均显示周围脑组织随后扩张，同时囊肿消失或大小显著减小。最初表现为头痛、偏瘫、视乳头水肿和复视的患者术后治愈。术前出现的头颅增大在分流术后未进展。然而，尽管囊肿已消失，但智力发育迟缓及行为问题术后仍无改善。1例囊肿-腹腔分流管发生感染，8例患者出现分流管故障。8例患者中有4例在分流管发生故障时出现颅内高压的急性症状和体征，尽管囊肿大小同时仅有轻微增加且未见脑室扩大。这4例患者的情况可被视为分流依赖。
囊肿-腹腔分流术是实现囊肿闭塞和临床改善的有效方法，手术风险低且并发症少。然而，应注意的是，部分患者在囊肿-腹腔分流术后会出现分流依赖。
