Abstract：
OBJECTIVE: Children diagnosed with suprasellar arachnoid cysts often concurrently have hydrocephalus. This study aims to classify the relationship between suprasellar arachnoid cysts and hydrocephalus, discussing surgical strategies-shunting or neuroendoscopic approaches-and their sequence, based on this classification.
METHODS: A retrospective analysis was conducted on 14 patients diagnosed with suprasellar arachnoid cysts and hydrocephalus, treated surgically by the first author between January 2016 and December 2020. Clinical features, radiological findings, surgical strategies, and outcomes were reviewed. The classification of the relationship between the suprasellar arachnoid cysts and hydrocephalus was developed and illustrated with specific cases. Recommendations for future surgical management based on this classification are provided.
RESULTS: We classified the relationship between suprasellar arachnoid cysts and hydrocephalus into three categories. SACH-R1, the direct type, represents cases where the cysts cause obstructive hydrocephalus. Here, neuroendoscopic ventriculocystocisternostomy (VCC) effectively treats both conditions. SACH-R2, the juxtaposed type, involves concurrent occurrences of cysts and hydrocephalus without a causative link. This is further subdivided into SACH-R2a, where acute progressive communicating hydrocephalus coexists with the cyst, initially managed with a ventriculoperitoneal shunt, followed by VCC upon stabilization of hydrocephalus; and SACH-R2b, where the cyst coexists with chronic stable communicating hydrocephalus, first addressed with VCC, followed by monitoring and potential secondary shunting if needed. Key factors differentiating SACH-R2a from SACH-R2b include the patient\'s age, imaging signs of fourth ventricle and cisterna magna enlargement, and the rapid progression or chronic stability and severity of hydrocephalus symptoms. SACH-R3, the reverse type, describes scenarios where shunting for hydrocephalus leads to the development or enlargement of the cyst, managed via neuroendoscopic VCC with precautions to prevent infections in existing shunt systems.
CONCLUSIONS: The simultaneous presence of suprasellar arachnoid cysts and hydrocephalus requires a nuanced understanding of their complex relationship for optimal surgical intervention. The analysis and classification of their relationship are crucial for determining appropriate surgical approaches, including the choice and sequence of shunting and neuroendoscopic techniques. Treatment should be tailored to the specific type identified, rather than blindly opting for neuroendoscopy. Particularly for SACH-R2a cases, we recommend initial ventriculoperitoneal shunting.
METHODS: A retrospective analysis was conducted on 14 patients diagnosed with suprasellar arachnoid cysts and hydrocephalus, treated surgically by the first author between January 2016 and December 2020. Clinical features, radiological findings, surgical strategies, and outcomes were reviewed. The classification of the relationship between the suprasellar arachnoid cysts and hydrocephalus was developed and illustrated with specific cases. Recommendations for future surgical management based on this classification are provided.
RESULTS: We classified the relationship between suprasellar arachnoid cysts and hydrocephalus into three categories. SACH-R1, the direct type, represents cases where the cysts cause obstructive hydrocephalus. Here, neuroendoscopic ventriculocystocisternostomy (VCC) effectively treats both conditions. SACH-R2, the juxtaposed type, involves concurrent occurrences of cysts and hydrocephalus without a causative link. This is further subdivided into SACH-R2a, where acute progressive communicating hydrocephalus coexists with the cyst, initially managed with a ventriculoperitoneal shunt, followed by VCC upon stabilization of hydrocephalus; and SACH-R2b, where the cyst coexists with chronic stable communicating hydrocephalus, first addressed with VCC, followed by monitoring and potential secondary shunting if needed. Key factors differentiating SACH-R2a from SACH-R2b include the patient\'s age, imaging signs of fourth ventricle and cisterna magna enlargement, and the rapid progression or chronic stability and severity of hydrocephalus symptoms. SACH-R3, the reverse type, describes scenarios where shunting for hydrocephalus leads to the development or enlargement of the cyst, managed via neuroendoscopic VCC with precautions to prevent infections in existing shunt systems.
CONCLUSIONS: The simultaneous presence of suprasellar arachnoid cysts and hydrocephalus requires a nuanced understanding of their complex relationship for optimal surgical intervention. The analysis and classification of their relationship are crucial for determining appropriate surgical approaches, including the choice and sequence of shunting and neuroendoscopic techniques. Treatment should be tailored to the specific type identified, rather than blindly opting for neuroendoscopy. Particularly for SACH-R2a cases, we recommend initial ventriculoperitoneal shunting.
摘要：
目的：诊断为鞍上蛛网膜囊肿的儿童常并发脑积水。本研究旨在对鞍上蛛网膜囊肿与脑积水的关系进行分类。讨论手术策略-分流或神经内镜方法-及其顺序，基于这种分类。
方法：对14例鞍上蛛网膜囊肿合并脑积水的患者进行回顾性分析。由第一作者于2016年1月至2020年12月进行手术治疗。临床特征,放射学发现，手术策略，并对结果进行了审查。开发了鞍上蛛网膜囊肿与脑积水之间关系的分类，并结合具体病例进行了说明。提供了基于此分类的未来手术管理建议。
结果：我们将鞍上蛛网膜囊肿与脑积水的关系分为三类。SACH-R1，直接型，代表囊肿导致梗阻性脑积水的病例。这里,神经内镜下脑室红细胞造口术（VCC）可有效治疗这两种疾病。SACH-R2，并列型，涉及囊肿和脑积水的并发发生，没有因果关系。这进一步细分为SACH-R2a，急性进行性交通性脑积水与囊肿共存，最初采用脑室-腹腔分流术,然后是脑积水稳定后的VCC；和SACH-R2b，囊肿与慢性稳定交通性脑积水共存，首先与VCC联系，其次是监测和潜在的二次分流，如果需要。区分SACH-R2a和SACH-R2b的关键因素包括患者的年龄，第四脑室和大脑池扩大的影像学征象，以及脑积水症状的快速进展或慢性稳定和严重程度。SACH-R3，反向类型，描述了分流脑积水导致囊肿发展或扩大的情况，通过神经内窥镜VCC进行管理，并采取预防措施，以防止现有分流系统中的感染。
结论：鞍上蛛网膜囊肿和脑积水的同时存在需要对其复杂的关系进行细致的了解，以进行最佳的手术干预。对其关系的分析和分类对于确定合适的手术入路至关重要,包括分流和神经内镜技术的选择和顺序。治疗应根据确定的特定类型进行调整，而不是盲目地选择神经内镜检查。特别是对于SACH-R2a案例，我们建议初次进行脑室-腹腔分流术.
方法：对14例鞍上蛛网膜囊肿合并脑积水的患者进行回顾性分析。由第一作者于2016年1月至2020年12月进行手术治疗。临床特征,放射学发现，手术策略，并对结果进行了审查。开发了鞍上蛛网膜囊肿与脑积水之间关系的分类，并结合具体病例进行了说明。提供了基于此分类的未来手术管理建议。
结果：我们将鞍上蛛网膜囊肿与脑积水的关系分为三类。SACH-R1，直接型，代表囊肿导致梗阻性脑积水的病例。这里,神经内镜下脑室红细胞造口术（VCC）可有效治疗这两种疾病。SACH-R2，并列型，涉及囊肿和脑积水的并发发生，没有因果关系。这进一步细分为SACH-R2a，急性进行性交通性脑积水与囊肿共存，最初采用脑室-腹腔分流术,然后是脑积水稳定后的VCC；和SACH-R2b，囊肿与慢性稳定交通性脑积水共存，首先与VCC联系，其次是监测和潜在的二次分流，如果需要。区分SACH-R2a和SACH-R2b的关键因素包括患者的年龄，第四脑室和大脑池扩大的影像学征象，以及脑积水症状的快速进展或慢性稳定和严重程度。SACH-R3，反向类型，描述了分流脑积水导致囊肿发展或扩大的情况，通过神经内窥镜VCC进行管理，并采取预防措施，以防止现有分流系统中的感染。
结论：鞍上蛛网膜囊肿和脑积水的同时存在需要对其复杂的关系进行细致的了解，以进行最佳的手术干预。对其关系的分析和分类对于确定合适的手术入路至关重要,包括分流和神经内镜技术的选择和顺序。治疗应根据确定的特定类型进行调整，而不是盲目地选择神经内镜检查。特别是对于SACH-R2a案例，我们建议初次进行脑室-腹腔分流术.
