| Part One Clinical Characteristics of Pediatric Intracranial Arachnold Cysts:an Analysis of 488 Cases Objective To summarizes the clinical features of pediatric intracranial arachnoid cysts(IACs). Methods Retrospectively analyzed 488 cases of pediatric IACs in our hospital from January 2003 to September 2013. Results The research included 488 patients with 342 males and 146 females( M:F=2.34:1, mean age 5.61±3.25 years). 221 cases(45.29%) were discovered accidentally, while 267 cases(54.71%) existed clinical chief complaints,which comprising 123 cases(46.07%) in responsibility. 364 cases(74.59%) were simple IACs, and 124 cases(25.41%) were associated with other congenital diseases. IACs located at the middle cranial fossa(355 cases,72.75%), the posterior fossa(82 cases,16.80%), the anterior cranial fossa(20 cases,4.10%), the cerebral convexity(12 cases,2.46%), the suprasellar cistern(7 cases,1.43%),the intraventricular(5 cases,1.02%),the quadrilateral cistern(5 cases,1.02%), and the inter hemispheres(2 cases,0.41%). 449 cases(92.01%) were single cyst,and 39 cases(7.99%) were multiple cysts. In an aspect of the tension effects based on imaging, 127 cases(26.02%) were positive, and 361 cases(73.98%) were negative. Then 76 cases(15.57%) took surgical operation, and 412 cases(84.43%) adopted the conservative treatment. After 3-72 months follow-up(mean 32.43 ± 8.92 months),the symptoms relieved and the volume of cysts reduced in operation cases in different degrees; while 407cases(98.78%) were stable, 3 cases(0.73%) worsened on clinical symptoms, and 2 cases(0.49%) were improved in the observation cases. Conclusion The clinical complaints of IACs in children were complicated, but only part could be determined the responsibility relations between the clinical complaints and IACs. Some IACs could be accompanied with other congenital diseases. Then in the natural history of IACs, most cysts maintained the stable volume. Only a few of IACs needed for operation intervention. Part Two Surgical Intervention Strategies for Pediatric Intracranial Arachnold CystsObjective To investigate the operation strategy of pediatric intracranial arachnoid cysts(IACs). Methods Surgical intervention was performed in 76 patients with pediatric IACs, admitted to our hospital from January 2003 to October 2013; cyst-peritoneal shunt was chosen in 40 patients and fistulation in 36(including microscopic fistulation in 31 and endoscopic fistulation in 5). According to the changes of cyst volume and the relief of symptoms, the efficacy was evaluated, and the complications after operation, including the recent complications(within 2 months after operation) and long-term complications(longer than 2 months after surgery) were observed. Results The efficiency of cysts-peritoneal shunt was 80%(32/40); the rate of recent complication for patients performed cysts-peritoneal shunt was approximately 17.5%(7/40), including 3 cases of CSF leakage, 3 cases of intracranial infection and 1 case of wound infection; the rate of long-term complications was approximately 22.5%(9/40), including 3 cases of shunt-dependency, 2 cases of intracranial infection, 2 cases of obstruction of the catheter, 1 case of off the catheter and 1 case of skin channel infections. Meanwhile, the efficiency of fistulation was approximately 91.67%(33/36); the rate of recent complication was approximately 8.33%(3/36), including 1 case of intracranial infection, 2 cases of subdural hematoma; the rate of long-term complications was 0. The no significant difference was noted in the surgical efficiency(χ2=1.126,P=0.289>0.05)and the rate of recent complication(Fisher’s exact test,P=0.201>0.05) between cyst-peritoneal shunt and fistulation; however, the rate of long-term complications in patients after cyst-peritoneal shunt insertion was significantly higher than that in patients after fistulation(Fisher’s exact test,P=0.002<0.05). Conclusion Fistulation might be the preferred method for pediatric IACs, and shunt should be avoided. |
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