Study On CT Cisternography And Endoscope Neurosurgery Of Intracranial Arachnoid Cysts

Background and objection:Intracranial Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1% of all intracranial space-occupying lesions. Sylvian fissure and Posterior Fossa arachnoid cysts were discovered for craniocerebral trauma frequently.It often caused Clinical symptoms because of the cyst may be increases gradually and brain tissue was compressed,and the Clinical symptoms mainly including intracranial hypertension,Epilepsy,Growth Retardation,Cranial nerve paresis. Pathogenesis of Arachnoid cysts still remain controversial,Now,there are two reasons of The Pathogenesis,one is Congenital,and the other is secondary sexual.Diagnosis and therapy of the Arachnoid cysts still remain controversial, At present,more and more neurosurgery Scholars command cysts of communicating intracranial arachnoid cyst and non-communicating intracranial arachnoid cyst. Through criteria that cyst whether or not communicate with subarachnoid space.The non-communicating intracranial arachnoid cyst is true cyst and communicating intracranial arachnoid cyst is also pseudocyst.The pseudocyst is brain tissue maldevelopment and enlarged cistern. since the advent of MRI and CT suggest a higher prevalence than previously thought. Diagnosis of Arachnoid cysts is upgrade tendency,but the MRI and CT are difficult to distinguish that brain tissue dysplasia geneogenous, enlarged cistern and Intracranial Arachnoid cysts.It is also had to distinguish NCIAC and CIAC. Literature reported that diffusion-weighted imaging and phase contrast imaging can identify the true cyst or pseudocyst.but our preliminary study confirmed that it were low accurate ratio.and the feasibility may be pending further to study and research. therefore, we suggest the CT cisternography, and confirmed that it is the best way to diagnosis and guide to therapy the Intracranial Arachnoid cysts. CTC was performed to 23 patients with intracranial arachnoid cysts preoperative, evaluate value of CT cisternography in the diagnosis and treatment of intracranial arachnoid cysts.Surgical indications and modalities in treatment of intracranial arachnoid cysts still remain controversial. there is no agreement among many views of the literature reported. At Present, domestic and abroad scholars think that the arachnoid cysts accompanied symptomatic of hypertension intracranial and epileptic seizure and Cranial nerve paresis should therapy with surgical procedures. But to therapy the arachnoid cysts with light Clinical symptoms and asymptomatic is controversial.some scholar presume these cysts should expectant treatment,and follow up Regularly.but there are some different opinions,they advocated that light Clinical symptoms and asymptomatic cysts should operate active, above all the teenagers patient.and believe that risks of expectant treatment are more than operation. Surgical modalities include micro-surgery,cystoperitonealshunt,Stereotaxis aspiration and endoscopical surgery. Neurosurgical Endoscope originate from at the beginning 20 century,but developed in our country beginning of near ten years.since the Neurosurgical Endoscope technique was introduced, Current literature favours endoscopic interventions for arachnoid cysts.but the Neuroendoscopic Treatment Effectiveness mey be doubt,because the following up with long-term and more case of a particular disease deficiency.our study adopted four Surgical modalities, and used retrospective analysis, collected clinical data, followed up the prostecdtive efficacy,for example:Clinical symptoms improving, information of the cysts. To approach curative effect of endoscope neurosurgery for intracranial arachnoid cysts.Methods:1.CT cisternography in the diagnosis and treatment of intracranial arachnoid cyst. CTC was performed to 23 patients with intracranial arachnoid cysts preoperative,and CTC and MRI was performed again to 8 patients postoperative,Characteristics were analysed by using of CTC and MRI iconography, conclude that the principle and value of CTC in the diagnosis and treatment. it can also give a primary evaluation to the effects of cranial cyst operation.2. Curative effect of endoscope neurosurgery for intracranial arachnoid cysts. Retrospective studies were performed on 192 cases of IAC, Supratentorial location of cysts was noted in 71.9% cases (n=138) while 28.1% cysts were located infratentorially (n=54).154 patients with intracranial arachnoid cysts who had accepted surgery,97 patients of them accepted endoscopical surgery, among of them 71 patients accepted simple endoscopical surgery,26 patients of them accepted endoscope-controlled microneuro-surgery,48 patients of them accepted micro-surgery,9 underwent cysto-peritonealshunt. Compared operation time and blood volume, complications and the information of Clinical symptoms and cyst size postoperative.To evaluate the best modus operandi of intracranial arachnoid cysts.3. The results were analyzed with SPSS13.0 software.with x2test and analysis of variance,difference significant at P<0.05.Results:1. CT cisternography in the diagnosis and treatment of intracranial arachnoid cyst.17 patients(17/23)were non-communicating intracranial arachnoid cysts(NCIAC), 6 patients(6/23) were communicating intracranial arachnoid cysts(CIAC). All of the NCIAC patients were performed neuroendoscopic surgery.The cyst of 1 patient disappeared,13 patients shrunk and 3 patients were still as big as properation.The symptoms of 3 patients(3/4) relieved. Postoperative CTC demonstrated that all the cysts of the 8 patients communicated well with the cistern.Our study demonstrated that Most of the Sylvian fissure arachnoid cysts are NCIAC (10/11), and 28.1% of posterior cranial fossa cysts were CIAC (5/10).2 patients of cerebral convexity were NCIAC.2. Curative effect of endoscope neurosurgery for intracranial arachnoid cysts.The postoperative Clinical symptoms improvement rates and shrinkage rates of the cysts were 89.5%,86.8%,88.9%and 81.5%,85.0% 88.9% respectively undergoing endoscopical surgery, micro-surgery and CPS. The operation time, bleeding volume and complications of the three group were 80.3±33.0mim,167.9±54.7min,94.2±26.1min and 15.9±10.9ml,219.2±172.8ml,16.7±5.6ml and 13.4%,29.2%,55.6%. Analysis of surgical methods to Sylvian fissure arachnoid cysts. There were 71 patients of postoperative follow-up.In the 51 patients of postoperative follow-up with pre-operative symptom,31 patients were symptom-free post-operatively, and 15 patients improved, the improvement rate were 90.1%.And 8 patients the cysts disappeared,50 patients reduced in size,13 patients did not change.The operation time and bleeding volume of simple endoscopical surgery group were 75.9±23.9min and 11.3±12.6ml,the endoscope-controlled microneuro-surgery group were 62.4±9.5 min and 9.7±5.9ml, the micro-surgery group were 159.8±56.2min and 222.7±184.6ml.Conclusions:1. CT cisternography is important to diagnose intracranial arachnoid cysts, especially to distinguish the brain tissue dysplasia geneogenous, enlarged cistern and Intracranial Arachnoid cysts, to make a definite diagnosis. CTC can give a operation sign to the cranial cysts and it can also give a primary evaluation to the effects of cranial cyst operation. The patients with asymptomatic and slight symptom made CT cisternography are necessary, although CT cisternography is traumatic occlusion, But it is a modus operandi that can make a definite diagnosis for Intracranial Arachnoid cysts2. Neuroendoscopic surgery is an effective method with tiny damnification, shorter operation time and less bleeding than craniotomy and CPS, Neuroendoscopic surgery is the best modus operandi of arachnoid cysts. But endoscope-controlled microneurosurgery only to enlarge the bone window,it can obtain surgery advantage of operate nimble and stop bleeding convenient and clear operative field for Intracranial Arachnoid cysts.Innovations of our study:1. CT cisternography is the reliable criteria to diagnose Intracranial arachnoid cysts to be put forward.and it can provide evidence forguiding treatment and judging therapeutic effect.Identify the indication for CT cisternography:l)The patients who are asymptomatic or slight symptom,and no iconography characteristic 2)The cysts comparatively large, general diameter larger than 3cm.3) Posterior cranial fossa arachnoid cysts, cisterna magna especially.4) Existing iconography characteristic of cysts but asymptomatic. Identify the indicatio curativa of neuroendoscopic surgery:1) Have clinical symptoms are relation with arachnoid cysts,and Existing iconography characteristic of cysts.2) the patients with asymptomatic or feeble symptom,and the arachnoid cysts identified by CT cisternography.3) The teenagers and cysts may be influence development of brain tissue, and diameter larger than 3cm generally.2. Followed up with long-term and large number of patients, the good prostecdtive efficacy of neuroendoscopic surgery was confirmed. neuroendoscopic surgery is the best effective method of arachnoid cysts to be put forward. and endoscope-controlled microneurosurgery have an advantage to simple endoscopical surgery. endoscope-controlled microneurosurgery is more suitable to treat sylvian fissure and convex surface and posterior fossa arachnoid cysts...