背景：颅内蛛网膜囊肿（AC）是良性的，脑膜蛛网膜层内的脑脊液填充空间。对儿童和年轻人的神经外科干预进行了广泛的研究，但老年人的最佳策略仍不清楚。因此,我们进行了一项单中心回顾性研究,并对文献进行了系统回顾,在老年队列中比较了膀胱腹膜(CP)分流术与其他手术入路.
方法：在2005年1月至2018年12月之间进行了回顾性神经外科数据库搜索，并使用PRISMA指南对文献进行了系统回顾。纳入标准：年龄60岁或以上，颅内AC的放射学诊断，神经外科介入,和神经放射学（NOG评分）/临床结果（COG评分）。将来自两个来源的数据汇总并进行统计分析。
结果：我们的文献检索产生了12项研究（34例患者），与我们的机构数据(13例患者)合并。CP分流（7例；15%），囊肿开窗术（28例；60％）和囊肿囊化/切除术（10例；21％）是最常见的方法。每种方法的平均随访时间为23.6、26.9和9.5个月，分别。手术干预的选择与NOG评分无统计学意义(P=0.417),COG评分(P=0.601),或并发症发生率(P=0.955)。然而,CP分流的并发症发生率最低，只有一名患者发展为慢性硬膜下血肿。
结论：CP分流术是老年人ACs安全有效的手术治疗策略。与其他方法相比，它具有相似的临床和放射学结果，但风险特征更高。我们提倡将CP分流作为老年人颅内AC的一线神经外科干预措施。
BACKGROUND: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic
review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort.
METHODS: Retrospective neurosurgical database search between January 2005 and December 2018, and systematic
review of the literature using PRISMA guidelines were performed. Inclusion criteria: Age 60 years or older, radiological diagnosis of intracranial AC, neurosurgical intervention, and neuroradiological (NOG score)/clinical outcome (COG score). Data from both sources were pooled and statistically analyzed.
RESULTS: Our literature search yielded 12 studies (34 patients), which were pooled with our institutional data (13 patients). CP shunts (7 patients; 15%), cyst fenestration (28 patients; 60%) and cyst marsupialisation/resection (10 patients; 21%) were the commonest approaches. Average duration of follow-up was 23.6, 26.9, and 9.5 months for each approach, respectively. There was no statistically significant association between choice of surgical intervention and NOG score (P = 0.417), COG score (P = 0.601), or complication rate (P = 0.955). However, CP shunting had the lowest complication rate, with only one patient developing chronic subdural haematoma.
CONCLUSIONS: CP shunting is a safe and effective surgical treatment strategy for ACs in the elderly. It has similar clinical and radiological outcomes but superior risk profile when compared with other approaches. We advocate CP shunting as first line neurosurgical intervention for the management of intracranial ACs in the elderly.
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