Abstract：
The aim of this cohort study was to describe and analyze the surgical treatment and outcome of posterior fossa arachnoid cysts (PFACs) in infants.
Patients presenting with a PFAC at infancy or prenatally, between the years 2000 and 2019, and who were surgically treated before the age of 2 years, were included in this study. Patient data were retrospectively collected including baseline characteristics and surgical variables. Factors related to revision surgery were analyzed through uni- and multivariate analysis.
Thirty-five patients, of whom 54.3% were male, were included. The cyst was diagnosed prenatally in 23 patients (65.7%). Surgery was typically recommended after a mean cyst follow-up of 3.4 ± 3.9 months, with a mean age at surgery of 6.1 ± 5.1 months. In 54.3% of patients (n = 19), surgery was performed before the age of 6 months. The PFAC was treated purely neuroendoscopically in 57.1% of patients (n = 20), while 28.6% of patients underwent open cyst procedures (n = 10), 5.7% (n = 2) were treated with a shunt, and 8.6% (n = 3) underwent a combined procedure. Additional surgery was required in 31.4% of patients (n = 11; mean 2.36 ± 2.11 surgeries per patient). At the last follow-up (61.40 ± 55.33 months), no mortality or permanent morbidity was seen; radiological improvement was apparent in 83.9% of the patients. Those patients treated before the age of 6 months (p = 0.09) and who presented before surgery with a stable cyst size that was maintained throughout preoperative monitoring (p = 0.08) showed a trend toward higher revision rates after surgical treatment.
PFACs in infancy may require surgical treatment before the age of 6 months. Navigated endoscopy was a valid surgical option. Overall mortality or permanent morbidity was rare. Additional surgery was required in up to 30% of the patients; younger age and a preoperatively stable cyst might be risk factors for revision surgery.
Patients presenting with a PFAC at infancy or prenatally, between the years 2000 and 2019, and who were surgically treated before the age of 2 years, were included in this study. Patient data were retrospectively collected including baseline characteristics and surgical variables. Factors related to revision surgery were analyzed through uni- and multivariate analysis.
Thirty-five patients, of whom 54.3% were male, were included. The cyst was diagnosed prenatally in 23 patients (65.7%). Surgery was typically recommended after a mean cyst follow-up of 3.4 ± 3.9 months, with a mean age at surgery of 6.1 ± 5.1 months. In 54.3% of patients (n = 19), surgery was performed before the age of 6 months. The PFAC was treated purely neuroendoscopically in 57.1% of patients (n = 20), while 28.6% of patients underwent open cyst procedures (n = 10), 5.7% (n = 2) were treated with a shunt, and 8.6% (n = 3) underwent a combined procedure. Additional surgery was required in 31.4% of patients (n = 11; mean 2.36 ± 2.11 surgeries per patient). At the last follow-up (61.40 ± 55.33 months), no mortality or permanent morbidity was seen; radiological improvement was apparent in 83.9% of the patients. Those patients treated before the age of 6 months (p = 0.09) and who presented before surgery with a stable cyst size that was maintained throughout preoperative monitoring (p = 0.08) showed a trend toward higher revision rates after surgical treatment.
PFACs in infancy may require surgical treatment before the age of 6 months. Navigated endoscopy was a valid surgical option. Overall mortality or permanent morbidity was rare. Additional surgery was required in up to 30% of the patients; younger age and a preoperatively stable cyst might be risk factors for revision surgery.
摘要：
目的：这项队列研究的目的是描述和分析婴儿后颅窝蛛网膜囊肿（PFACs）的手术治疗和结果。
方法：婴儿期或产前出现PFAC的患者，在2000年至2019年之间，在2岁之前接受手术治疗，包括在这项研究中。回顾性收集患者数据，包括基线特征和手术变量。通过单因素和多因素分析与翻修手术相关的因素。
结果：35名患者，其中54.3%是男性，包括在内。23例(65.7%)产前诊断为囊肿。通常建议在平均囊肿随访3.4±3.9个月后进行手术。手术时的平均年龄为6.1±5.1个月。在54.3%的患者（n=19）中，手术在6个月大之前进行。57.1%的患者（n=20）采用单纯神经内镜治疗PFAC，而28.6%的患者接受了开放性囊肿手术(n=10)，5.7％（n=2）用分流治疗，8.6%(n=3)接受了联合手术。31.4％的患者需要进行其他手术（n=11；平均每位患者进行2.36±2.11手术）。末次随访（61.40±55.33个月），没有发现死亡或永久性发病率;83.9%的患者放射学改善明显.那些在6个月大之前接受治疗的患者（p=0.09），并且在手术前表现出稳定的囊肿大小，并且在整个术前监测过程中（p=0.08），显示出手术治疗后翻修率更高的趋势。
结论：婴儿期的PFACs可能需要在6个月大之前进行手术治疗。导航内窥镜检查是一种有效的手术选择。总死亡率或永久性发病率很少见。多达30％的患者需要进行额外的手术；年龄年轻和术前稳定的囊肿可能是翻修手术的危险因素。
方法：婴儿期或产前出现PFAC的患者，在2000年至2019年之间，在2岁之前接受手术治疗，包括在这项研究中。回顾性收集患者数据，包括基线特征和手术变量。通过单因素和多因素分析与翻修手术相关的因素。
结果：35名患者，其中54.3%是男性，包括在内。23例(65.7%)产前诊断为囊肿。通常建议在平均囊肿随访3.4±3.9个月后进行手术。手术时的平均年龄为6.1±5.1个月。在54.3%的患者（n=19）中，手术在6个月大之前进行。57.1%的患者（n=20）采用单纯神经内镜治疗PFAC，而28.6%的患者接受了开放性囊肿手术(n=10)，5.7％（n=2）用分流治疗，8.6%(n=3)接受了联合手术。31.4％的患者需要进行其他手术（n=11；平均每位患者进行2.36±2.11手术）。末次随访（61.40±55.33个月），没有发现死亡或永久性发病率;83.9%的患者放射学改善明显.那些在6个月大之前接受治疗的患者（p=0.09），并且在手术前表现出稳定的囊肿大小，并且在整个术前监测过程中（p=0.08），显示出手术治疗后翻修率更高的趋势。
结论：婴儿期的PFACs可能需要在6个月大之前进行手术治疗。导航内窥镜检查是一种有效的手术选择。总死亡率或永久性发病率很少见。多达30％的患者需要进行额外的手术；年龄年轻和术前稳定的囊肿可能是翻修手术的危险因素。
