鞍上池囊肿的扩大机制和治疗预后分析

Mechanism of suprasellar arachnoid cyst enlargement and therapeutic approach

目的 探讨鞍上池囊肿(SAC)的扩大机制和手术入路,提高治愈率和减少复发率。方法 回顾性分析上海交通大学医学院附属上海儿童医学中心神经外科2012年9月—2021年9月收治的72例SAC患儿,依据MRI影像分为局限型(49例)和扩展型(23例),伴有脑积水者49例。神经内镜下经额叶入路行三脑室底-囊肿-桥前池造口术(EVCC) 60例,经颞部入路行囊肿-桥前池造口术(CC) 9例,显微镜下CC 3例。术中观察囊壁结构,桥前池有无粘连等,术后定期影像复查和评价疗效。结果 囊壁光滑与基底动脉间有裂隙状孔49例,平均年龄48.8个月,囊壁上有异位脉络丛组织17例,平均年龄9.7个月,后者发病就诊年龄显著早于前者(P=0.007)。术后随访3~60月,平均随访(16.8±13.6)个月,接受EVCC的囊肿缩小成功率为100%,CC为66.7%,脑积水加重5例,经脑室-腹腔分流术好转。结论 囊肿的裂隙活瓣及异位脉络丛分泌脑脊液是鞍上池囊肿的主要扩大机制,EVCC可达到一次手术治愈的满意疗效。鞍上池囊肿常致梗阻性脑积水,但部分患者同时存在交通性脑积水。

Objective To explore the mechanism of suprasellar arachnoid cyst(SAC)enlargement and determine optimum surgical methods.Methods 72 patients with SAC admitted to Shanghai Children s Medical Center,School of Medicine,Shanghai Jiaotong University from September 2012 to September 2021 were analyzed retrospectively.The patients were divided into localized type(49 cases)and extended type(23 cases).49 cases were accompanied with varying degree of hydrocephalus.60 patients underwent endoscopic third ventriculocystocisternostomy(EVCC)through frontal approach.9 patients underwent endoscopic cystocisternostomy(CC)through temporal approach.3 patients underwent microscopic CC.The anatomical structure of the cyst walls and cisternal environment were observed.The complication and curative effects were recorded during postoperative follow-up.Results The slit-valves between SAC and basilar artery were found in 49 cases during operation and the average age was 48.8 months.Choroidal heterotopias were found in 17 cases during operation and the average age was 9.7 months.The cyst wall structure of 6 cases were not recorded.The mean clinical follow-up period was(16.8±13.6)months.The cure rate was higher for EVCC(100%)than for CC(66.7%).Hydrocephalus aggravated in 5 cases who improved after ventriculoperitoneal shunt.Conclusions Slit-valve and choroidal heterotopia may play an important role in the mechanism of SAC enlargement.EVCC is a safe and effective modality for this cyst.However,a small number of children with communicating hydrocephalus still need shunt operation.