神经内镜下脑池造瘘术治疗儿童颅内蛛网膜囊肿

Neuroendoscopic cisternostomy for the treatment of pediatric intracranial arachnoid cysts

目的分析神经内镜下脑池造瘘术治疗儿童颅内蛛网膜囊肿(IACs)的临床疗效。方法回顾性纳入郑州大学第一附属医院神经外科2010年1月至2017年8月采取神经内镜下脑池造瘘术治疗的儿童IACs患者,共31例。随访其临床疗效。结果31例患儿中,有症状者术后临床症状改善率为91.0%(20/22)。随访时间为13 ~36个月,平均(21.0±5.6)个月;与术前比较(中位数:52.5 ml;P25,P75:31.3 ml,167.6 ml),术后3个月(中位数:27.8 ml;P25,P75:15.6 ml,42.3ml)、12个月(中位数:22.5 ml;P25,P75:13.9 ml,34.9 ml)的囊肿体积缩小率分别为(62.5±15.7)%、(68.3±12.8)%,差异具有统计学意义(均P<0.05)。31例患儿围手术期共7例(22.6%)发生并发症,其中发热2例,硬膜下积液3例,头皮下积液2例。随访期仅有1例(3.2%)患儿出现顽固性皮下积液。结论神经内镜下脑池造瘘术治疗儿童IACs术后并发症发生率低,疗效良好。

Objective To evaluate the clinical efficacy of neuroendoscopic cisternostomy for the treatment of intracranial arachnoid cysts (IACs) in children. Methods Thirty-one children in total with IACs who underwent neuroendoscopic cisternostomy from January 2010 to August 2017 at Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled. All cases were followed up in the aspect of clinical efficacy. Results Among 31 children, the improvement rate of clinical symptoms was 91.0%(20/22) in symptomatic patients after operation. The follow-up period ranged from 13 to 36 months, with an average of 21.0±5.6 months. Compared with preoperative data (Mean: 52.5 ml;P25, P75: 31.3 ml, 167.6 ml), the means of shrinkage rates of cyst volume at 3 months (Mean: 27.8 ml;P25, P75: 15.6 ml, 42.3 ml) and 12 months (Mean: 22.5 ml;P25, P75: 13.9 ml, 34.9 ml) post operation were 62.5+ 15.7% and 68.3+ 12.8% respectively with significant statistical differences (all P<0.05). Complications occurred in 7 (22.6%) cases during perioperative period, including fever in 2, subdural effusion in 3 (volume of effusion decreased significantly in 3 months and disappeared in 12 months after operation without obvious symptoms or particular treatment) and subcutaneous effusion in 2 cases. During the follow-up period, only 1 (3.2%) child developed intractable subcutaneous effusion. Conclusion Neuroendoscopic cisternostomy for the treatment of IACs in children seems safe and effective.