| BackgroundIntracranial arachnoid cysts(IACs)are cysts formed by abnormal fluid accumulation between two layers of intracranial arachnoids,which do not involve the brain parenchyma.Most of them are congenital lesions in the cerebrospinal fluid pool.The prevalence of children About 1.3%to 2.6%[1-4].IACs are mostly congenital,and patients are usually asymptomatic.They are often found accidentally during imaging studies of head trauma,epilepsy,and stunting.A small number of IACs show symptoms such as headache,epilepsy,dizziness,and limb movement disorders.Patients usually do not recommend surgery[2,4-7].With the wide application of imaging technology,more and more IACs are found,and more and more clinical symptoms are reported.Lang et al.[8]first reported advanced cognitive process disorders in 10 adult patients with temporal and frontal arachnoid cysts(AC)in 1985;subsequent reports[9-14]reported that IACs may Lead to different cognitive disorders,and AC decompression(neuroendoscopy cystostomy,craniotomy cystectomy,cyst-peritoneal drainage)can reduce or even return to normal;but there are also studies[4;15]showed that patients with IACs had no cognitive impairment,and there was no significant difference between patients' cognition after surgery and before surgery.ObjectiveThis study aims to explore whether IACs affects the normal development of children's cognitive function and whether decompression surgery of IACs can improve children's cognitive function,so as to provide more clinical reference for the diagnosis and treatment of IACs.Method1.From January 2 018 to August 2019,a total of 49 children(observation group)with IACs under the age of 14 who underwent surgical treatment in the Fifth Affiliated Hospital of Zhengzhou University underwent preoperative and 6 months postoperative cognitive function testing Score and collect case data.Data of normal children who were born in our hospital or studied in nearby schools were collected,and 49 children(control group)with the same age,gender,education level and guardian education level as above were screened out,and their cognitive functions were tested immediately and 6 months later;2.According to the age,the observation group and the control group were each divided into a group of 0.5 to 2 years(9 cases each),a group of 2 to 8 years(23 cases each),and a group of 8 to 14 years(17 eases each);3.The cognitive function test scores of children in the observation group before and after 6 months of different age groups were compared with each other,and the cognitive function test scores immediately after 6 months of the corresponding age group were compared with the control group.Linear regression analysis was performed on the size of IACs and cognitive function score,and the improved cognitive function score after three surgical methods was compared and analyzed.ResultsThe preoperative scores of the 0.5 to 2 years old group in the observation group were not different from the immediate scores of the 0.5 to 2 years old group in the control group(P=0.730).The 2 to 8 years old group and the 8 to 14 years old group in.the observation group had no preoperative scores.The scores were lower than those in the 2 to 8 years old group and the 8 to 14 years old group in the control group(P<0.05,P=0.002);the 0.5 to 2 years old group in the preoperative observation group scored higher than 2 to 8 The age group and the age group of 8 to 14 years(P=0.004,P=0.011);there was no correlation between the age of the children in the 0.5 to 2 years old group and the age of 8 to 14 years old in the preoperative observation group(P=0.831,P=0.898),age and scores in the 2 to 8 years old group showed a significant negative and moderate correlation(P=0.001,r=-0.645);the scores of 0.5 years old to 2 years old and 8 years old to 14 years old in the postoperative observation group were lower than those of the control group 6 months later(P=0.008,P=0.011).There was no difference between the 2-8 years old group and the observation group(P=0.574).The AC size had a weak negative relationship with the preoperative score(P=0.027,r=-0.350,r2=0.099);AC scores of middle and posterior fossa children were lower than normal children(P=0.016,P=0.037),and AC scores of middle and posterior fossa children were lower.There was no difference(P=0.381);the scores of the endoscopic group and the shunt group were higher than those of the microscope group(P=0.009,P=0.034).There was no difference in the score improvement between the endoscope group and the shunt group(P=0.679);there was no difference in AC reduction after the three surgical methods(P=0.215);the number of hospital stays in the endoscope group was less than that of the microscope group and the shunt group(P=0.001,P<0.05).),There was no difference in the number of hospital stays between the microscope group and the shunt group(P=0.643);one case of subdural hematoma occurred in the endoscopic group,and the hematoma disappeared after drilling and drainage;one case of intracranial infection occurred in the microscope group,and antibiotics were administered.He improved after treatment;there was no postoperative limb movement disorder or death.conclusion1.IACs can hinder the development of neurocognitive function in children after 2 years old,but the average cognition of children can be within the normal range of the corresponding age standard population;2.The larger the maximum cross-sectional diameter of IACs was,the worse the cognitive function development of the children.However,the diameter of IACs had little influence on the cognitive development,and there was no difference in the overall cognitive development between middle cranial fossa AC and posterior cranial fossa AC;3.Cognitive function can be improved to close to normal children when 2 to 8 years old,and cognitive function can be partially improved when 8 to 14 years old;4.Neuroendoscopic cyst wall resection plus fistula and cyst-peritoneal shunt are more conducive to the improvement of children's cognitive development than endoscopic cyst wall resection plus fistula. |
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