背景:中窝蛛网膜囊肿(MFACs)很少见,先天性病变可能破裂并引起颅内压升高的症状。我们试图描述在MCAC中视神经水肿的存在和相关因素,重点关注眼科评估对指导囊肿治疗的实用性。
方法:我们回顾了在我们机构进行眼科评估的所有MCF患者的临床和影像学信息。头痛,颅神经麻痹,呕吐,精神状态改变,疲劳,癫痫发作被认为是MFAC相关症状。单变量和多变量分析评估了与视神经水肿相关的因素。
结果:纳入了2003年至2022年的51例患者。囊肿的中位体积为169.9cm3(四分位间距:70.5,647.7)。19例(37.3%)患者发生硬膜下血肿/水瘤破裂的证据。18例(35.3%)患者因囊肿和/或破裂相关的颅内出血而接受了手术。11例(21.6%)患者出现视神经水肿;所有患者均有症状并经历囊肿破裂。这些患者中有10人接受了手术。术后,80%的病例解决了视神经水肿。囊肿体积和症状与视神经水肿无关;然而,囊肿破裂患者,尤其是那些有创伤性破裂的人,更有可能发生视神经水肿和接受手术(P<0.001)。
结论:我们发现21.6%的评估的MCO出现视神经水肿,占破裂病例的57.9%。在未破裂的囊肿中未发现视水肿。囊肿开窗术可改善视神经水肿和患者症状。结合临床病史和神经影像学,视神经水肿可能有助于指导MFAC治疗,尤其是囊肿破裂患者。
BACKGROUND: Middle fossa arachnoid cysts (MFACs) are rare, congenital lesions that may rupture and cause symptoms of elevated intracranial pressure. We sought to describe the presence of and factors associated with optic nerve edema in MFACs, focusing on the utility of ophthalmologic evaluations for guiding cyst management.
METHODS: We reviewed clinical and radiographic information for all patients with MFACs with ophthalmologic evaluations at our institution. Headache, cranial nerve palsy, emesis, altered mental status, fatigue, and seizures were considered MFAC-related symptoms. Univariate and multivariable analyses evaluated factors associated with optic edema.
RESULTS: Fifty-one patients between 2003 and 2022 were included. Cysts were a median volume of 169.9 cm3 (interquartile range: 70.5, 647.7). Evidence of rupture with subdural hematoma/hygroma occurred in 19 (37.3%) patients. Eighteen (35.3%) patients underwent surgery for their cyst and/or rupture-associated intracranial bleed. Eleven (21.6%) patients had optic edema; all were symptomatic and experienced cyst rupture. Ten of these patients received surgery. Postoperatively, optic edema resolved in 80% of cases. Cyst volume and symptoms were not associated with optic edema; however, patients with ruptured cysts, particularly those with traumatic rupture, were more likely to have optic edema and receive surgery (P < 0.001).
CONCLUSIONS: We found optic edema in 21.6% of evaluated MFACs, and this comprised of 57.9% of ruptured cases. Optic edema was not found in unruptured cysts. Cyst fenestration improved optic edema and patient symptoms. In conjunction with clinical history and neuroimaging, optic edema may help guide MFAC management, particularly in patients with cyst rupture.