儿童鞍上蛛网膜囊肿的内镜治疗及疗效评估

目的探讨脑室镜下脑室-囊肿-脑池造瘘术（VCC）治疗儿童鞍上蛛网膜囊肿（SACs）的临床治疗及疗效评估方法。方法回顾性分析2017年5月—2021年11月首都儿科研究所附属儿童医院神经外科收治的SACs患儿的临床资料，患儿术前均行头CT平扫、头MRI平扫及矢状位磁共振三维稳态进动快速成像序列（3D-FIESTA）评估，根据术前影像及术中所见将SACs分为两种类型：Ⅰ型基底动脉位于囊肿内，Ⅱ型基底动脉位于囊肿下方。手术方式均采用脑室镜下VCC。患儿于术后1周、1个月、3个月、6个月及1年行头颅MRI平扫和矢状位3D-FIESTA序列，评估脑室大小变化情况、囊肿变化情况及脑脊液通路改善情况。结果共纳入8例患儿(年龄1.5个月～3岁10个月)。8例SACs中7例Ⅰ型，1例Ⅱ型。8例患者均顺利完成VCC。无手术死亡及术后感染患者。术后平均随访时间36个月。术后2例患者出现短期轻微硬膜下积液，均在1个月内自行消失。术后3D-FIESTA序列示囊肿均明显减小或消失，中脑导水管及双侧室间孔均通畅，造瘘口通畅。6例患者术后脑积水症状消失，脑室缩小，术前症状消失。2例患者术后脑积水未缓解，1例术后1个月行内镜探查术见造瘘口通畅即行脑室腹腔分流术，1例于术后3个月行脑室腹腔分流术。2例脑积水未缓解患者虽然经分流治疗，但均有不同程度的发育落后。结论脑室镜下VCC治疗SACs微创且有效，磁共振3D-FIESTA序列可清晰评估囊肿术前及术后情况。

Objective To investigate the clinical treatment and efficacy of ventriculocystocisternostomy(VCC) for children with suprasellar arachnoid cysts(SACs). Methods The clinical data of children with SACs admitted to the Department of Neurosurgery, the Affiliated Children’s Hospital, Capital Institute of Pediatrics from May 2017 to November 2021 were reviewed. All children were evaluated by head CT plain scan, head MRI plain scan and sagittal 3D-FIESTA MRI before operation. According to the preoperative images and introperative view, the SACs were divided into two types, one with basilar artery located inside the cyst(Type Ⅰ) and the other under the cyst(Type Ⅱ). The follow-up MR including 3D-FIESTA were performed one week, one month, three months, six months and one year after operation to evaluate the change of ventricular and cystic size and improvement of the obstacle of the cerebrospinal fluid circulation. Results 8 patients were included in this study(1.5 months to 3 years and 10 months). VCC was successfully performed in all the 8 patients. 7 cases were Type Ⅰ and 1 case was Type Ⅱ. There were no deaths or infection after operation. The postoperative average follow-up time was 36 months. After operation, 2 patients had slight subdural effusion in a short time, which disappeared spontaneously within 1 month. Postoperative 3D-FIESTA sequence showed that the cysts were significantly reduced or disappeared, the mesencephalic aqueduct and bilateral interventricular foramen were unobstructed, and the fistulae were unobstructed. In 6 patients, hydrocephalus disappeared, ventricles shrank, and preoperative symptoms disappeared. 2 had no remission of hydrocephalus after operation. 1 underwent ventriculoperitoneal shunt when endoscopic exploration showed that the fistula was unobstructed 1 month after operation, and another patient underwent ventriculoperitoneal shunt 3 months after operation. Although 2 patients with unresponsive hydrocephalus were treated by shunt, their development was lagging behind to varying degrees. Conclusions Endoscopic VCC is an minimally invasive and effective procedure for SACs. 3D-FIESTA sequences of Magnetic Resonance could clearly estimate the condition of cyst before and after operation.