囊肿-蛛网膜下腔造瘘术对中颅窝蛛网膜囊肿儿童认知功能的影响

The effect of cyst-subarachnoid fistula on the cognitive function of children with middle cranial fossa arachnoid cyst

目的探讨囊肿-蛛网膜下腔造瘘术对中颅窝蛛网膜囊肿儿童认知功能的影响。方法将2018年2月—2021年2月经我院门诊确诊并进行囊肿-蛛网膜下腔造瘘术治疗的40例中颅窝蛛网膜囊肿患儿作为手术组,将同期收治入院但拒绝手术并要求保守随访观察的40例中颅窝蛛网膜囊肿患儿作为保守组。观察记录手术组患儿术后临床症状改善情况、并发症发生情况,同时比较两组患儿囊肿体积变化与认知功能评分。结果手术组患儿术前存在61项症状,术后28项临床症状完全消失(占45.90%,28/61),23例项临床症状缓解(占37.70%,23/61),10项临床症状无改善(占16.39%,10/61),主要以癫痫症状为主。随访6个月,手术组与保守组患儿语言智商(VIQ)、操作智商(PIQ)、总智商(FIQ)评分均明显升高,但手术组认知功能各项评分均高于保守组(P<0.05)。手术组术后囊肿缩小1/2以上患儿12例,囊肿缩小1/2~1/3患儿7例、囊肿缩小1/3以下或无变化患儿1例,保守组囊肿缩小1/2以上患儿5例,囊肿缩小1/2~1/3患儿9例、囊肿缩小1/3以下或无变化患儿6例,两组术后囊肿缩小1/3以上变化比较存在差异(χ^(2)=4.329,P=0.037)。40例中颅窝蛛网膜囊肿手术组患儿术后6个月出现1例颅内感染,2例硬膜下积液。结论应用囊肿-蛛网膜下腔造瘘术治疗中颅窝蛛网膜囊肿儿童的效果较好,安全且创伤小,同时能有效改善患儿认知功能与临床症状,可考虑为该类疾病的首选手术治疗方式。

Objective To investigate the effect of cyst-subarachnoid fistula on the cognitive function of children with middle cranial fossa arachnoid cyst. Methods From February 2018 to February 2021, 40 children with arachnoid cysts in the middle cranial fossa who were diagnosed and treated by cyst-subarachnoid fistula in our hospital from February 2018 to February 2021 were treated as the surgical group. 40 children with arachnoid cyst in the middle cranial fossa admitted to the hospital during the same period but refused surgery and requested conservative treatment were selected as conservative group.The postoperative improvement of clinical symptoms and the occurrence of complications in the children in the operation group were observed and recorded. At the same time, the cyst volume changes and cognitive function scores of the two groups of children were compared. Results Children in the surgical group had 61 symptoms before surgery, 28 clinical symptoms disappeared completely after surgery(45.90%, 28/61), 23 clinical symptoms were relieved(37.70%, 23/61), and 10 clinical symptoms were absent improvement(16.39%, 10/61), mainly with epilepsy symptoms. Six months after treatment, the verbal intelligence quotient(VIQ), performance intelligence quotient(PIQ), and full-scale intelligence quotient(FIQ) scores of children in the surgical group and the conservative group were significantly increased, but the cognitive function scores of the surgical group were higher than those in the conservative group(P<0.05). In the surgical group, 12 children had cysts reduced by more than 1/2, 7 children had cysts reduced from 1/2 to 1/3, and 1 child had cysts reduced by less than 1/3 or unchanged. In the conservative group, there were 5 children with cysts shrank above 1/2, 9 children with cysts reduced by 1/2 to 1/3, and 6 children with cysts reduced by less than 1/3 or no change. There were differences in the changes of cysts reduced by more than 1/3 between the two groups(χ^(2)=4.329, P=0.037). In the 40 cases of cranial fossa arachnoid cyst surgery group, 1 case of intracranial infection and 2 cases of subdural effusion occurred 6 months after the operation. Conclusion The application of cyst-subarachnoid fistula in treatment of children with middle cranial fossa arachnoid cyst is effective, safe and less traumatic,which can effectively improve the cognitive function and clinical symptoms of children. It can be considered as the first choice treatment methods for this type of disease.