| Object: Arachnoid cyst is a common intracranial space-occupying lesion,comprising 1-2% of all intracranial space-occupying lesions.Middle cranial fossa is most common for intracranial arachnoid cyst,but its operation method is not uniform.To provide a reference for the choice of operative method,this article compares the outcome of three operative methods including craniotomy,cysto-peritoneal shunting,and neuroendoscopic fenestration for middle cranial fossa arachnoid cyst.Methods: We retrospectively reviewed the patient diagnosed as arachnoid cyst in Shengjing Hospital of China Medical University from January 2012 to August 2018,totally 301 patients.Based on inclusion and exclusion criteria,we selected 69 patients.Depending on the operation method,we divided them into three groups: craniotomy(craniotomy group),cysto-peritoneal shunting(shunt group),and neuroendoscopic fenestration(endoscopic group).We compare the differences among the three surgical methods including sex,age,clinical symptoms,cyst side,preoperative size,operation time,short-term symptom improvement,short-term cyst size,short-term complications,long-term symptom improvement,long term cyst size,long-term complications,length of stay,hospitalization expenses.Results: Among 69 cases of middle cranial arachnoid cyst,52 cases were male,17 cases were female,male was more than female.50 cysts were located in the left side and 19 cysts were in the right side.Middle fossa cysts were predominantly left-sided.The average age of the three groups was 8.93 ± 9.50.There was no statistical difference in sex,side and age(P> 0.05).The pre-operation size of cysts in shunt group was significantly different from that in craniotomy group and endoscopic group(P< 0.05),but there was no significant difference between craniotomy group and endoscopic group(P> 0.05).The most common symptom of arachnoid cyst in the middle cranial fossa was headache,epilepsy.Also,nausea,vomiting,dizziness,malformation of skull,body movement disorder,speech retardation,hyperactivity disorder can happen.In some patients,cysts are asymptomatic and found on examination.The operative time in the craniotomy group is longer than that in the shunt group(P<0.01).The operative time in the endoscopic group has no significant difference with craniotomy group,shunt group(P> 0.05).The rate of recent clinical symptoms improvement among three groups has no difference(P> 0.05).One postoperation cyst in cranitomy group was larger,others were smaller.The rate of recent cyst reduction has no difference(P> 0.05).Craniotomy group had 6 cases of intracranial infection,2 cases of intracranial air accumulation and 1 case of subdural hematoma.Endoscopic group had a case of intracranial infection.No complication in the shunt group.There was no statistical difference among the three groups(P> 0.05).The long-term symptoms of craniotomy group,shunt group and endoscopy group were not improved in 2 cases respectively.There was no statistical difference among the three groups(P> 0.05).One postoperation cyst in endoscopic group and one in craniotomy group was larger,others were smaller.There was no significant difference in the reduction long-term of cysts among the three groups(P> 0.05).There were 2 cases of subdural fluid accumulation in the craniotomy group,one in the shunt group and one case of subdural hematoma in the endoscopic group.There was no statistical difference among the three groups(P> 0.05).In the comparison of length of stay,there was difference between craniotomy group and shunt group(P<0.05).There was no significant difference between the endoscopic group and the craniotomy group as well as shunt group(P> 0.05).There was significant difference among the three groups(P < 0.01)on hospitalization expenses,and the endoscopic group cost the least.Conclusion: Craniotomy,cysto-peritoneal shunting,and neuroendoscopic fenestration have good effect on middle cranial fossa arachnoid cysts.There was no statistical difference on treatment result between the three surgical methods.Endoscopic fenestration can take less cost of hospitalization. |
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