额颞蛛网膜囊肿认知功能障碍及其在神经内镜术后近期和远期的情况比较

Short-term and long-term outcome on cognitive dysfunctions of patients with neuroendoscopic surgery for frontotemporal arachnoid cysts

目的探讨额颞蛛网膜囊肿(FTAC)认知功能障碍及其神经内镜术后近期和远期的改善情况。方法纳入29例FTAC手术(Ⅰ组)、16例FTAC非手术(Ⅱ组)、10例健康人(Ⅲ组)分别在术前2周(T1)、术后3个月(T2)、术后1年(T3)或相等的时间段间隔点进行认知功能测验,采用重复测量方差分析比较评分;T1时3组量表评分行效度、信度检验,Ⅰ组和Ⅱ组额颞间、左右间评分均行t检验,颞叶囊肿不同Galassi分型间评分行方差分析。结果3组间评分差异有统计学意义(P<0.05),不同时间点间差异有统计学意义(P<0.05),存在交互作用(P<0.05):T1时Ⅰ组和Ⅱ组差异无统计学意义(P>0.05),但均差于Ⅲ组(P<0.05);T2或T3时Ⅰ组评分较T1改善(P<0.05)。T1时,效度检验因子载荷均>0.80,克朗巴赫系数0.70,额颞间评分差异无统计学意义(P>0.05),左侧抑制/转换测验评分差于右侧(P<0.05),不同Galassi分型间评分差异无统计学意义(P>0.05)。结论FTAC可引起基本和高级认知功能障碍;神经内镜术后认知功能改善,疗效长久稳定;认知功能障碍可作为术前考虑的手术适应证;左侧囊肿可能影响言语应变;囊肿大小与认知功能障碍缺少相关性。

Objective To evaluate the efficacy on cognitive dysfunctions of neuroendoscopic surgery for fronto- temporal arachnoid cysts ( FTAC).Methods Twenty - nine patients with FTAC treated with neuroendoscopic surgery ( Group Ⅰ),16 patients with FTAC treated with no surgery ( Group Ⅱ) and 10 healthy volunteers ( Group Ⅲ) were in- cluded in the study.Cognitive function tests were performed 2 weeks before microsurgery ( T1),3 months after microsur- gery ( T2),and 1 year after microsurgery ( T3);or at the equal time intervals.Repeated measure ANOVA was performed using SPSS 13. 0.At T1,scale scores among the 3 groups were tested in validity and reliability.T - test was performed between the scores of frontal and temporal,and left and right in Group Ⅰ and Ⅱ,and ANOVA was applied among Galassi classifications of temporal cysts.Results The differences in cognitive function scores were significant among the 3 groups and at 3 time - points,with significant interactions ( P < 0. 05).At T1,the difference in cognitive function scores was not significant between Group Ⅰ and Group Ⅱ( P > 0. 05),both were significantly less than Group Ⅲ( P < 0. 05).In Group Ⅰ,the difference in cognitive function scores was significant between T1 and T2 or T3 ( P < 0. 05).At T1,the va- lidity test loaded factors was over 0. 8,Cronbach's α was 0. 70,the difference was not significant between frontal and tem- poral or among Galassi classifications ( P > 0. 05).The inhibition /switching test of left was significantly less than right ( P < 0. 05).Conclusion FTAC could lead to basic or high cognitive dysfunctions,which was stably improved after neu- roendoscopic surgery.Cognitive dysfunctions should be considered as indication of operation.Left cysts could impact upon verbal flexibility.Cognitive dysfunctions is not correlated with cyst volume.