目的:症状性颅内蛛网膜囊肿主要通过手术切除治疗,内镜开窗术,或通过植入膀胱腹膜(CP)分流术。然而,特定技术的使用仍然存在争议。这项研究的目的是讨论有症状的颅内蛛网膜囊肿(ACs)患者的这些手术方式,并通过比较可变的术前和术后参数来研究哪种手术方式具有更好的预后和更少的并发症。
方法:对2009年至2023年在神经外科接受颅内蛛网膜囊肿手术的39例有症状的患者进行了分析。根据年龄组对患者进行回顾性比较,性别,解剖位置,偏侧性,干预类型,临床和体积变化,术后并发症和预后。
结果:在39例患者中,20例(51.28%)患者接受CP分流术。11例患者(28.2%)接受了内镜开窗术,8例患者(20.5%)进行了手术切除。首次手术时的年龄范围为1个月至59.9岁(平均年龄:16.8岁),儿科患者为25例(64.1%)。最常见的初始症状是头痛,在19例患者中观察到(48.7%),其次是癫痫发作12例(30.8%),11例病人呕吐(28.2%),视觉功能障碍8例(20.5%),8例患者嗜睡(20.5%),8例患者出现视觉症状(20.5%),认知障碍4例(10.3%),局灶性神经功能缺损3例(7.7%),1例(2.6%)受累脑神经。24例患者(61.5%)表现出改善,而15例患者(38.5%)症状持续或恶化。术后,患者平均随访1年.改善率最高的是内镜开窗术,有9例改善患者(81.8%),其次是手术切除5例无症状患者(62.5%)。在膀胱腹膜分流术中观察到最坏的结果,只有一半的患者得到缓解(50%)。2例(25%)手术切除患者出现并发症,5例(45.5%)患者进行了内镜开窗术,和13例(65%)进行膀胱腹膜分流的患者。
结论:内镜开窗术的改善率最高,最低的严重并发症以及侵入性最小的技术。这些特征使其成为治疗AC的最佳方式。当患者报告症状不变或恶化时,手术切除或膀胱腹膜分流术可被视为辅助技术。
Symptomatic intracranial arachnoid cysts are treated mainly through surgical resection, endoscopic fenestration, or by implanting cystoperitoneal (CP) shunt. However, the use of a specific technique remains controversial. The purpose of this
study is to discuss these surgical modalities in symptomatic patients with intracranial arachnoid cysts (ACs) and investigate which has better outcomes and less complications by comparing variable preoperative and postoperative parameters.
An analysis of thirty-nine symptomatic patients who underwent intracranial arachnoid cyst surgery in the department of neurosurgery between 2009 and 2023 was performed. Patients were retrospectively compared based on age group, gender, anatomical location, laterality, type of intervention, clinical and volumetric changes, postoperative complications and outcome.
Of the 39 patients, 20 patients (51.28 %) received CP shunt. Eleven patients (28.2 %) underwent endoscopic fenestration, and 8 patients (20.5 %) had surgical resection. The age at the time of first operation ranged from 1 month to 59.9 years (mean age: 16.8 years), and the pediatric patients were 25 (64.1 %). The most common initial symptom was headache which was observed in 19 patients (48.7 %), followed by seizure in 12 patients (30.8 %), vomiting in 11 patients (28.2 %), visual dysfunction in 8 patients (20.5 %), drowsiness in 8 patients (20.5 %), visual symptoms in 8 patients (20.5 %), cognitive impairment in 4 patients (10.3 %), focal neurological deficits in 3 patients (7.7 %), and cranial nerve involvement in 1 patient (2.6 %). 24 patients (61.5 %) showed improvement while in 15 patients (38.5 %) the symptoms persisted or worsened. Postoperatively, patients were followed up for an average of one year. The highest improvement rate was noted in endoscopic fenestration with 9 improved patients (81.8 %), followed by surgical resection with 5 symptom-free patients (62.5 %). The worst outcomes were seen in cystoperitoneal shunt with only half of the patients were relieved (50 %). Complications developed in 2 patients (25 %) who underwent surgical resection, 5 patients (45.5 %) who had endoscopic fenestration, and 13 patients (65 %) who had cystoperitoneal shunting.
Endoscopic fenestration has the highest improvement rate, the lowest serious complications along with being the least invasive technique. These features make it the optimal modality in treatment of ACs. Surgical resection or cystoperitoneal shunt can be considered as secondary techniques when patients report unchanged or worsening symptoms.