| Objective:To analyze the clinical efficacy of pureneuroendoscopy in the treatment of quadrigeminal cistern arachnoid cysts.Methods:Retrospective analysis of clinical data of 15 patients with QCAC who underwent neuroendoscopic surgery from July 2008 to January 2019 in the First Affiliated Hospital of Kunming Medical University,to observe the improvement of clinical symptoms before and after surgery,changes in the Karnofsky Performance Status(KPS)score,changes in the diameter of the cyst,the efficacy of different surgical procedures,and the recurrence rate of the cyst.Fifteen patients underwent the following surgical procedures based on cyst location and hydrocephalus:lateral ventriculo-cystostomy(LV C),endoscopic third ventriculostomy(ETV),LVC+ventricle-Peritoneal shunt(ventriculoperitoneal shunt,VP)and LVC+ETV.Regular follow-up of 15 patients was performed to understand the long-term prognosis of the patients.Results:A total of 15 patients with clinically diagnosed QCAC and undergoing neuroendoscopic surgery were enrolled,including 10 males and 5 females,with a sex ratio of 2:1,a minimum age of 2 months,and a maximum age of 45 years and 18 years.11 patients under 18 years old,4 patients over 18 years old.After 15 patients underwent surgery,the symptoms disappeared in 8 patients(53.3%),and the symptoms were alleviated in 7 patients(46.7%).The mean scores of preoperative and postoperative KPS functional status in 15 patients were(64.6±15.9)and(88±17.4),the scores of patients after surgery were significantly improved,the difference was statistically significant(t=-3.82,P=0.001);the maximum diameter of preoperative and postoperative cysts were(3.91±1.23)cm and(3.03±0.98)cm,respectively.The difference was statistically significant(t=2.156,P=0.04);of the 15 patients,7 received LVC,2 received LVC+ETV,4 received LVC+VP,and 2 received ETV with KPS score Patients with different surgical methods were compared.The results showed that there was no statistical difference in the functional status scores of patients with different surgical procedures(LVC:t=-2.582,P=0.063;LVC+ETV:t=-5,P=0.192;LVC+VP:t=-2.33,P=0.058;ETV:t=-3,P=0.095).Four patients(26.6%)had symptoms repeated after discharge.The MRI of the head showed that the intracranial cyst was larger than that of the hospital.The second operation was performed.The postoperative recovery was good and there were no new clinical symptoms.Two patients(13%)had poor healing of the incision after operation,and the wound had hydrocephalus effluent,which was cured after dressing and pressure dressing.Four of the 15 patients(26.6%)were lost to follow-up.The longest follow-up time was 98 months,the shortest follow-up time was 7 months,and the average follow-up time was 39.2 months.The follow-up showed that the maximum diameter of cysts in 11 patients was not significantly different from the last discharge.Changes,and no new clinical symptoms.Conclusions:Endoscopic surgery for QCAC has the advantages of minimally invasive,obvious symptom relief,normal circulation of normal hydrocephalus,short operation time,and good postoperative recovery.The incidence of QCAC is lower than that of other intracranial arachnoid cysts.However,because of the special growth position,it is easy to squeeze the midbrain aqueduct,which is more likely to cause hydrocephalus and lead to symptoms of high blood pressure.QCAC is prone to recurrence,which may be related to the blood supply of the cyst wall and the closure of the fistula. |
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