Posterior fossa arachnoid cysts and cerebellar tonsillar descent: short review
Posterior fossa arachnoid cysts and cerebellar tonsillar descent: short review
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DOI：
10.1007/s10143-010-0262-9
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发表时间：
2010-07-01
影响因子：
2.8
通讯作者：
Martinez-Lage, Juan F.
中科院分区：
文献类型：
--
作者：
Galarza, Marcelo;Lopez Lopez-Guerrero, Antonio;Martinez-Lage, Juan F.
本研究的目的是分析后颅窝蛛网膜囊肿患者小脑扁桃体下降与脊髓空洞症的关系。我们回顾了 10 名被诊断患有后颅窝蛛网膜囊肿和扁桃体下降的患者（平均年龄 33；范围 24-49 岁）的医疗记录。症状平均持续 12 个月（范围为 6 个月至 3 年）。六例患者出现脊髓空洞症。 6 例患者接受了枕骨下颅骨切除术，3 例患者接受了额外的 C1 椎板切除术，还有 1 例患者接受了有限的颅骨切除术和扁桃体缩小术。三名患者还接受了脑积水治疗：一名患者接受脑室腹腔分流术，两名患者接受内镜下第三脑室造口术。两名患者接受了保守治疗。后颅窝蛛网膜囊肿位于小脑蚓池 (n = 4)、小脑半球 (n = 2)、小脑桥脑角 (n = 3) 和四叠体池 (n = 1)。一名软骨发育不全患者表现出扁平足的特征。相关畸形包括一名被诊断为毛鼻指综合征的患者的颅面畸形和一名原发性颞部蛛网膜囊肿的患者。平均随访 2 年（范围为 3 个月至 5 年）后，四名患者的神经系统症状得到缓解，两名患者的眼部症状持续存在。 4 例头痛和颈项痛有所改善，4 例持续存在。四名患者的脊髓空洞症得到解决，两名患者的脊髓空洞症得到改善。患有后颅窝蛛网膜囊肿的患者可能会出现获得性 Chiari 畸形和脊髓空洞症。初始治疗应针对枕骨大孔减压，并应包括切除蛛网膜囊肿壁。针对特定情况，可以采取观望态度。根据我们的经验，在治疗蛛网膜囊肿之前应妥善解决脑积水问题。
The objective of this study was to analyze the association of cerebellar tonsillar descent and syringomyelia in patients with posterior fossa arachnoid cysts. We reviewed the medical records of ten patients (mean, age 33; range, 24-49 years) diagnosed with posterior fossa arachnoid cyst and tonsillar descent. Symptoms evolved over a mean of 12 months (range, 6 months to 3 years). Syringomyelia was present in six cases. Six patients underwent a suboccipital craniectomy, three cases underwent an additional C1 laminectomy, and a further case had a limited craniectomy and tonsillar reduction. Three patients were also treated for hydrocephalus: one with a ventriculoperitoneal shunt and two with endoscopic third ventriculostomy. Two patients had conservative treatment. The posterior fossa arachnoid cysts were located at the vermis-cisterna magna (n = 4), the cerebellar hemispheres (n = 2), the cerebellopontine angle (n = 3), and the quadrigeminal cistern (n = 1). A patient with achondroplasia showed features of platybasia. Associated malformations included craniofacial dysmorphism in a patient diagnosed of trichorhinophalangeal syndrome and a case with a primary temporal arachnoid cyst. After a mean follow-up of 2 years (range, 3 months to 5 years), four patients showed resolution of their neurological symptoms, and two exhibited persisting ocular findings. Headaches and nuchalgia improved in four cases and persisted in four. Syringomyelia was resolved in four patients and improved in two. Patients harboring a posterior fossa arachnoid cyst may evolve with acquired Chiari malformation and syringomyelia. Initial management should be directed to decompressing the foramen magnum and should include the resection of the arachnoid cyst's walls. A wait-and-see attitude can be implemented in selected cases. In our experience, hydrocephalus should be properly addressed before treating the arachnoid cyst.