Fewel M E, Levy M L, McComb J G
Division of Neurosurgery, Children's Hospital of Los Angeles, CA 90027, USA.
Pediatr Neurosurg. 1996 Oct;25(4):165-73. doi: 10.1159/000121119.
Our review of 95 children with 102 intracranial arachnoid cysts treated surgically from 1976 to 1996 is presented. These patients are divided into two groups, those initially treated from 1976 to 1986 and those treated from 1987 to May 1996, to see whether any improvement in outcome had occurred. There were 31 patients (20 males/11 females) with 34 cysts treated from 1976 to 1986 and 64 patients (45 males/19 females) with 68 cysts treated from 1987 to 1996. The mean age at presentation for all cases was 4.9 years (range from 3 days to (7.8 years). The most common cyst location was the middle fossa. Treatment options for the management of intracranial arachnoid cysts include fenestration or shunting. We consider the avoidance of a shunt as a primary goal in the management of these patients. Accordingly, 82 (80%) of the cysts in our series were treated initially by fenestration. Fifty percent of those initially fenestrated from 1976 to 1986 required no further treatment as compared with 60% fenestrated from 1987 to 1996. The success rate of fenestration among those patients without associated hydrocephalus was significantly higher than in those with hydrocephalus; 73% without hydrocephalus required no additional treatment versus 32% with hydrocephalus. Seventeen percent of the patients treated from 1976 to 1986 required a subsequent ventriculoperitoneal shunt as compared with 22% treated from 1987 to 1996. Twenty-nine percent of those patients initially fenestrated from 1976 to 1986 required a subsequent cystoperitoneal shunt as compared with only 12% treated from 1987 to 1996. Although not statistically significant, the second group of patients had a lower rate of reoperation, fewer complications, and a better clinical outcome than the first group. We recommend that in patients without evidence of hydrocephalus, cyst fenestration be considered as the primary procedure, as 73% of the patients in the two series remain shunt free. In those patients with hydrocephalus, we still recommend cyst fenestration, but with a ventriculoperitoneal shunt inserted before fenestration if the hydrocephalus is marked or after fenestration if the hydrocephalus is progressive.
本文对1976年至1996年间接受手术治疗的95例患有102个颅内蛛网膜囊肿的儿童进行了回顾性研究。这些患者被分为两组，一组是1976年至1986年期间首次接受治疗的患者，另一组是1987年至1996年5月期间接受治疗的患者，以观察治疗效果是否有所改善。1976年至1986年期间，有31例患者（20例男性/11例女性）接受了34个囊肿的治疗；1987年至1996年期间，有64例患者（45例男性/19例女性）接受了68个囊肿的治疗。所有病例的平均就诊年龄为4.9岁（范围从3天至7.8岁）。最常见的囊肿位置是中颅窝。颅内蛛网膜囊肿的治疗选择包括开窗术或分流术。我们将避免进行分流术作为这些患者治疗的主要目标。因此，在我们的系列病例中，82个（80%）囊肿最初采用了开窗术治疗。1976年至1986年期间最初接受开窗术治疗的患者中，有50%无需进一步治疗，而1987年至1996年期间接受开窗术治疗的患者这一比例为60%。无相关脑积水的患者开窗术的成功率显著高于有脑积水的患者；无脑积水的患者中73%无需额外治疗，而有脑积水的患者中这一比例为32%。1976年至1986年期间接受治疗的患者中有17%随后需要进行脑室腹腔分流术，而1987年至1996年期间接受治疗的患者中这一比例为22%。1976年至1986年期间最初接受开窗术治疗的患者中有29%随后需要进行囊肿腹腔分流术，而1987年至1996年期间接受治疗的患者中这一比例仅为12%。虽然无统计学意义，但第二组患者的再次手术率较低、并发症较少且临床结局较好。我们建议，对于无脑积水证据的患者，应将囊肿开窗术视为主要治疗方法，因为两个系列中的73%患者无需进行分流术。对于有脑积水的患者，我们仍然建议进行囊肿开窗术，但如果脑积水明显，则在开窗术前插入脑室腹腔分流管；如果脑积水呈进行性发展，则在开窗术后插入。
