儿童中颅窝蛛网膜囊肿手术治疗42例报告

Surgical treatment of pediatric patients with middle fossa arachniod cysts: report of 42 cases

目的儿童中颅窝蛛网膜囊肿(MFAC)是一种比较常见的良性颅内占位性病变,但是目前学界对于其外科手术治疗的指征及方法仍有很大争议。本研究的目的意在结合我们临床实践经验及文献复习对这些争议进行探讨。方法对我院2011年9月至2015年9月间收治的行神经内镜辅助囊肿-基底池造瘘术(39例)及囊肿-腹腔分流术(3例)的42例儿童中颅窝蛛网膜囊肿患者的临床资料进行回顾性分析,并结合文献复习探讨儿童MFAC的外科治疗指征,手术方式,临床及神经影像学预后。结果所有患者随访3~36月(平均随访18月),39例(92.8%)临床有效(至少有一种症状改善或完全治愈),临床症状完全消失者为30例(71.4%)。临床症状中高颅压表现缓解最为明显(治愈率达81.25%;有效率100%)。造瘘术后囊肿缩小及消失37例(95.0%),无一例患儿死亡及出现严重的神经功能损伤。结论相较于囊肿-腹腔分流手术,神经内镜囊肿-脑池造瘘术同样安全有效,但创伤小。所以对于儿童MFAC的治疗,建议应采取相对积极的态度,治疗方法首选神经内辅助囊肿-脑池造瘘术,但对于每个个体病例需行严格评估,选择最优的治疗方式。

Objective Middle fossa arachnied cyst （MFAC） in child is a common benign space-occupying intracranial lesion. Its optimal strategy and indication to surgical treatment has been controversial. This study aims to discuss the controversial issues in combining with the clinical experiences and literature review. Methods The clinical data of 42 pediatric patients that underwent surgeries to treat MFAC （endoscopic cyst fenestration were performed in 39 eases and cystperitoneal shunt were performed in 3 cases） from September 2011 to September 2015 in our hospital were analyzed retrospectively and the surgical treatment, indication and imaging features of MFAV in child were studied in combination with literature review. Results All the patients were followed up for 3 ~ 36 months （mean 18 months）. Thirty-nine patients （92. 8% ） had a satisfactory clinical outcome and the clinical symptoms disappeared completely in 30 cases （71.4%）. Among the clinical manifestation intracranial hypertension had a significant improvement after surgery （cure rate： 81.25%; effective rate： 100% ）. After cyst fenestration, the cyst was reduced in size or completely disappeared in 37 patients （95.0%）. There was no death or significant morbidity associated with procedure. Conclusion Compared to cystperitoneal shunting, endoscopic fenestration is also effective with more safety and less injury. For MFAC in child, endoscopic fenestration is the first recommendation, but the optimal surgical strategy should be made according to the individual characteristics of patients.