背景:中窝蛛网膜囊肿(MFAC)是儿童最常见的颅骨囊肿之一,囊肿开窗后的各种术后并发症是一个主要问题。我们在我们部门进行了一项回顾性研究,并对文献进行了系统回顾,以确定并发症的危险因素。
方法:对2019年1月至2020年12月接受显微镜开窗术的38例MFAC患者(<14岁)进行了回顾性调查。术后并发症,包括术后出血/血肿,硬膜下积液(SH),颅神经麻痹,术后中枢神经系统感染,脑脊液(CSF)泄漏,被收集。对1980年后发表的经手术治疗的MFAC进行了系统的PubMed搜索。对纳入研究的术后并发症进行了说明。
结果:我们系列的总并发症发生率为7.9%,其中,9例(23.7%)患者术后出现SH,其中之一需要囊肿-腹膜分流术。患有SH的患者明显年轻(4.0±1.8vs.6.3±3.4年,p=0.012)。二元逻辑分析表明,年龄较低可能是发展SH的危险因素(比值比:0.738,p=0.067)。一名患者出现硬膜下血肿。未观察到颅神经麻痹或脑脊液渗漏。18项研究纳入了系统评价,包括649例MFAC。最常见的并发症是SH(4.9%),显微镜和内镜技术的术后并发症发生率相似。
结论:MFAC开窗术的并发症发生率相当高。SH是术后最常见的并发症,它主要发生在幼儿身上。应严格的手术指征适用于幼儿。
BACKGROUND: Middle fossa arachnoid cyst (MFAC) is one of the most common cranial cysts in children, and the various postoperative complications following cyst fenestration represent a major concern. We conducted a retrospective study in our department and performed a systematic review of the literature to identify the risk factors for complications.
METHODS: A retrospective survey was conducted in 38 patients with MFAC (<14 years) who underwent microscopic fenestration from January 2019 to December 2020. Postoperative complications, including postoperative hemorrhage/hematoma, subdural hygroma (SH), cranial nerve palsy, postoperative central nervous system infection, and cerebrospinal fluid (CSF) leak, were collected. A systematic PubMed search for cohort studies on surgically treated MFAC published after 1980 was performed. The postoperative complications in the included studies were illustrated.
RESULTS: The overall complication rate in our series was 7.9%, among whom, 9 patients (23.7%) developed postoperative SH, one of which required cyst-peritoneal shunting. Patients who developed SH were significantly younger (4.0 ± 1.8 vs. 6.3 ± 3.4 years, p = 0.012). Binary logistic analysis showed that a lower age could be a risk factor for developing SH (odds ratio: 0.738, p = 0.067). One patient developed a subdural hematoma. No cranial nerve palsy or CSF leak was observed. Eighteen studies were included in the systematic review, comprising 649 cases of MFAC. The most common complication was SH (4.9%), and the postoperative complication rates were similar between the microscopic and endoscopic techniques.
CONCLUSIONS: The complication rate of MFAC fenestration is considerable. SH is the most common postoperative complication, and it mostly occurs in young children. Strict surgical indications should be applied for young children.