The Clinical Efficacy Of Surgical Treatment For Arachnoid Cyst In Middle Cranial Fossa In Children

BackgroundIntracranial arachnoid cysts are formed in the fashion of accumulation of fluid resembling cerebrospinal fluid,accounting for approximate 1%of intracranial space-occupying diseases,and this rate in children is about 2.6%^[1-2].In 1819,Howship initially reported the case of intracranial arachnoid cysts.In 1831,Bright described IACs as the lesion of arachnoid content containing clear fluid.In 1978,Starkman and others used a series of equipment such as light and electron microscopy to take many pictures of IACs,unraveling the mysterious veil of IACs and knowing about many in-depth factors of IACs including shape,size and location etc.In 1991,Pascual-troubleviejo proposed that IACs accounted for about 1.3%of intracranial space-occupying diseases,and affirmed that the incidence of IACs was clearly from0.1%to 0.5%via autopsy^[3-5].IACs can be divided into primary and secondary arachnoid cysts.The mechanism of IACs is still controversial.For some researchers,it is believed that primary IACs are caused by congenital abnormal embryonic development,which leads to the separation or duplication of arachnoids.In that case,the accumulation of fluid resembling CSF would come into existent gradually.Acquired IACs are mainly caused by head trauma,inflammation,intracranial hemorrhage or surgical trauma^[6-7].Most IACs are asymptomatic and difficult to detect and diagnose.However,with the wider development and application of CT,MRI,prenatal B-mode ultrasound and other imaging technologies,more and more IACs are detected in advance.IACs are mostly located on the supratentorial surface,such as the middle cranial fossa,suprasellar cistern,lateral ventricle,convex surface of the brain,quadrilateral cistern and so on.Subtentorial IACs are relatively rare,such as cerebellum,occipital cistern and cerebellopontine angle^[8-10].Arachnoid cysts in the middle cranial fossa have the highest proportionate,accounting for about50%⁶0%.There is still much controversy about the indications and methods of operation for the treatment of arachnoid cysts in middle cranial fossa^[10-11].The purpose of this research is to collect,analyze and summarize the relevant clinical data of the children with arachnoid cysts in the middle cranial fossa who received treatment in our hospital,and to evaluate and analyze the best surgical methods of arachnoid cysts in the middle cranial fossa so as to provide clinical treatment for these diseases in the aspect of reference resources.ObjectiveTo analyze and evaluate the clinical efficacy of distinct surgical treatment options for arachnoid cysts in the middle cranial fossa in children respectively.MethodsA retrospective study was conducted on 98 children with arachnoid cysts in middle cranial fossa under 15 years old admitted to the First Affiliated Hospital of Zhengzhou University from November 2014 to February 2018.They were divided into neuroendoscopy group,microscopic group and cyst-peritoneal?C-P?shunt group according to the operation methods.Results?1?The sources in C-P shunt group were better than the ones of neuroendoscopy group and microscopy group in the aspect of operation time and intraoperative blood loss;the data in microscope group was the largest in these two aspects,and the level of sources of neuroendoscopy group was in the middle,with significant statistical differences.?2?The average of the rate of cyst shrinkage at 3 months after operation:C-P shunt group>microscope group>neuroendoscopy group,there was no significant statistical difference;the average of the rate of cyst shrinkage at 12 months after operation in C-P shunt group was significantly higher than that in microscope group and neuroendoscopy group,and the difference had statistical significance.?3?The overall improvement rate of symptoms in neuroendoscopy group?90.1%?was higher than that in microscopy group?87.5%?and C-P shunt group?68.9%?,and there was significant statistical difference.?4?The incidence of short-term complications in neuroendoscopy group,microscopy group and C-P shunt group was 33.3%,39.6%and 28.1%respectively,and there was no significant statistical difference in the incidence of short-term complications.In terms of the incidence of long-term complications,the one of C-P shunt group?40.6%?was significantly higher than that of microscopy group?14.6%?and neuroendoscopy group?11.1%?in the aspect of statistics.ConclusionsAll the three methods can significantly reduce the volume of arachnoid cysts in the middle cranial fossa in children and improve the preoperative clinical symptoms of children to a great extent.Compared with neuroendoscopic and microscopic surgery,cyst-peritoneal shunting is simple and easy to operate,and the degree of operation requirements is relatively low.However,considering that there are significant differences in the fashion of clinical efficacy,complications and prognosis of the three groups,neuroendoscopic sugery in the treatment of arachnoid cysts in middle cranial fossa of children has the advantages of small trauma,good effect,low incidence of complications and easy to deal with.Overall,neuroendoscopic sugery can be considered as the most rational choice of surgical treatment for arachnoid cysts in middle cranial fossa in children.