四叉系蛛网膜囊肿：影响预后和并发症的因素。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-02-01 DOI:10.1016/j.clineuro.2024.108701

Harsh Deora, Mohammed Nadeem, Himanshu YN, Joginapalli Anirudh, Abhinith Shashidhar, Subhas Kanti Konar, Vikas V, Arivazaghan A, Dhaval P. Shukla, Dwarakanath Srinivas, Malla Bhaskara Rao

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引用次数: 0

摘要

目的：蛛网膜囊肿约占颅内肿块病变的1 %，其中四叉池蛛网膜囊肿占5-18 %。本研究报告了一系列的31例四分生池蛛网膜囊肿，构成迄今为止报道的最广泛的系列。方法：回顾性分析31例经诊断为四叉腹腔蛛网膜囊肿的患者的临床表现、人口学特征、治疗方法及转归。患者年龄从6岁 到45岁，平均年龄29岁。根据MRI表现将囊肿分为三种亚型，所有患者均接受手术治疗。结果：31例患者中，1型囊肿7例，2型12例，3型12例。对于1型囊肿患者，内镜下第三脑室造瘘加囊肿开窗6例，开颅1例。2型囊肿行分流术3例：开颅切除囊肿壁4例，单纯行ETV 3例，囊肿开窗2例。3型囊肿11例行腔内蛛网膜下腔或脑室开窗，联合腔内第三脑室造口术，1例开颅。所有3例分流术、1例开颅术和2例开窗ETV均因症状需要翻修手术（6/31例）。3例脑室内出血，2例需要体外引流。6例翻修病例中的4例在第一次手术后的MRI上显示囊肿大小没有缩小。结论：股四叉盘状蛛网膜囊肿具有典型的症状，需要手术治疗。我们的研究结果显示，2型和3型囊肿最常见。分流术不建议作为首选手术，因为分流术效果不佳。内镜开窗与ETV仍然是选择的程序，而ETV单独可能在大多数情况下就足够了。出血和感染降低了成功率。

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Quadrigeminal arachnoid cyst: Factors affecting outcomes and complications in a large series of cases

Purpose

Arachnoid cysts constitute approximately 1 % of intracranial mass lesions, with quadrigeminal cistern arachnoid cysts being 5–18 % of those. This study presents a series of 31 cases of quadrigeminal cistern arachnoid cysts, constituting the most extensive series reported to date.

Methods

A retrospective analysis was conducted on 31 patients diagnosed with quadrigeminal cistern arachnoid cysts, focusing on clinical presentation, demographics, treatment approaches, and outcomes. Patient ages ranged from 6 m to 45 years, with a mean age of 29. The cysts were classified into three subtypes based on MRI findings, and all patients underwent surgical intervention.

Results

Of the 31 patients, 7 had Type 1 cysts, 12 had Type 2 cysts, and 12 had Type 3 cysts. For patients with Type 1 cysts, endoscopic third ventriculostomy with cyst fenestration was done in 6 cases, with craniotomy in 1 one case. In those with Type 2 cysts, Shunt was done in 3 cases: craniotomy with cyst wall excision in 4, ETV alone in 3, and cyst fenestration in 2. For Type 3 cysts, 11 patients underwent endoscopic fenestration to the subarachnoid space or ventricles, combined with endoscopic third ventriculostomy, and craniotomy was done in one case. All three shunts, one craniotomy, and 2 ETV with fenestration needed revision surgery due to symptoms(6/31 cases). Three cases had an intraventricular haemorrhage, with 2 cases needing external drainage. Four of the six revision cases showed no reduction in cyst size on MRI after the first surgery.

Conclusion

Quadrigeminal plate arachnoid cysts typically present with symptoms and necessitate surgical treatment. Our findings show that Type 2 and 3 cysts are the most common. Shunts are NOT indicated as the first procedure, as they have poor results. Endoscopic fenestration with ETV remains the procedure of choice, while ETV alone may suffice in most cases. Bleeding and infection reduce success rates.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.