RU2214172C2 - Method for draining arachnoid cyst of the brain - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves creating anastomosis connecting of the lateral cerebral fissure arachnoid cyst cavity and cavity of the lateral cisterna ponti. Walls of the mentioned formations are partially excised at the place they are adjacent to each other. EFFECT: recovered physiological liquor circulation; reduced risk of bypass dependence arising. 2 dwg

Description

 The invention relates to medicine, namely to neurosurgery, and can be used for surgical treatment of arachnoid cysts of the lateral brain slit in children.

 Several methods are known for draining arachnoid cysts of the brain: cystoperitoneal shunting, communication of the cyst cavity with the subarachnoid space of the cerebral hemispheres, communication of the cyst with the lumen of the lateral ventricle.

A known method of drainage of an arachnoid cyst of the brain using a shunt system in the abdominal cavity. (Pascual-Castroviejo I, Roche MC, Martinez Bermejo A, Arсas J, Garcia Blazquez M: Primary intracranial arachnoidal cysts. A study of 67 childhood cases. J. Child's Nerv Syst 1991. Vol. 7 (5). P.257- 63.)
The disadvantages of the method:
- shunt dependence of patients;
- shunt occlusion with protein masses and fibrin with high protein content in cystic contents;
- inefficiency of the shunt system in the presence of a multi-chamber cyst;
- shunt infection and high risk of meningitis;
- the relative shortening of the length of the shunt with continued growth of the child.

A known method of draining arachnoid cysts of the brain by communicating the cavity of the cyst with the subarachnoid space of the cerebral hemispheres. (Samuel F. Ciricillo, Philip H. Cogen, Giffith R. Harsh, Michael SB Edwards: Intracranial arachnoid cysts in children. J. Neurosurg. 1991. Vol. 74. P.230-235.)
Arachnoid cysts are a congenital pathology - a malformation of the arachnoid membrane. The leading link in the pathogenesis is impaired cerebrospinal circulation, drainage function of the subshell spaces of the brain and resorption of cerebrospinal fluid. In connection with this circumstance, the method of drainage of an arachnoid cyst with subarachnoid spaces of the hemispheres loses all sense, since with this disease the drainage function of the subshell spaces and the resorption of cerebrospinal fluid are initially impaired. As a result of the application of this method, there is no complete restoration of circulation and resorption of cerebrospinal fluid, since there is a productive inflammation in the membranes of the brain.

 The prototype of the invention is a method of draining an arachnoid cyst of the brain into the lumen of the lateral ventricle of the brain. (Pierre-Kahn A, Capelle L. Sainte-Rose C, Renier D, Hoppe-Hirsch E, Hirsch JF: Treatment of suprasellar arachnoid cysts by percutaneous transfrontal ventriculocystostomy. Apropos of a series of 17 cases. Neurochirurgie 1990. Vol. 36 ( 6). P.370-377). The essence of the operation of the prototype is as follows. Osteoplastic trepanation of the skull is performed in the right or left temporal region, depending on the location of the cyst. The dura mater is dissected with a flap, the base of the sagittal sinus. Open the cavity of the cyst, evacuate its contents. Then, the outer wall of the cyst is excised, i.e. its shell in the area where it is not connected with the substance of the brain. Further, intracystic septa and trabeculae are excised. After this, an anastomosis is made between the cavity of the arachnoid cyst and the lumen of the lateral ventricle by dissecting the brain substance in a blunt or sharp way or establishing a catheter. The dura mater is sutured tightly, the bone defect is laid in its place and fixed. In other cases, craniotomy is replaced by percutaneous puncture of the cyst cavity, followed by its communication with the cavity of the lateral ventricle of the brain.

The disadvantages of the prototype:
- as a result of the communication of the cavity of the lateral ventricle with the cavity of the arachnoid cyst, a porencephalic cyst is formed, leading to the dislocation of the middle structures of the brain. Porencephalic cyst is often the cause of the development of epileptic syndrome;
- there is a risk of ventriculitis in the presence of infection, since the ventricular lumen with this method has free communication with the cerebrospinal fluid spaces of the cerebral hemispheres;
- the invasiveness of the method due to the fact that at the time of imposing anastomosis of the cavity of the cyst with the lumen of the lateral ventricle, damage to the pathways of the brain is possible;
- the need for visual control during percutaneous puncture of the cyst requires additional expensive equipment.

 The invention is aimed at creating a method for draining arachnoid cysts of the brain, which ensures the restoration of normal physiological circulation of cerebrospinal fluid without increasing the risk of developing shunt-dependent, epileptic syndrome and infectious complications. The proposed method is economically more affordable.

 The invention consists in the following. Surgically, an anastomosis is formed between the cavity of the arachnoid cyst of the lateral slit of the brain and the cavity of the lateral cistern of the bridge by partially excising the walls of these formations of the arachnoid membrane in the place of their direct contact. Formed anastomosis provides drainage of the arachnoid cyst of the brain.

 The invention is illustrated by drawings, where Fig. 1 shows a schematic representation of a congenital arachnoid cyst of the right lateral slit of the brain, which does not communicate with the cerebrospinal fluid spaces, behaves as a volumetric process, compressing and displacing the right temporal lobe. Figure 2 shows the formed anastomosis between the opened arachnoid cyst and the cavity of the lateral cistern of the bridge during the performed osteoplastic craniotomy.

 The drawings show: the wall of the arachnoid cyst 1, the wall of the lateral cistern of the bridge 2, the base of the anterior cranial fossa 3, the left temporal lobe 4, the compressed right temporal lobe 5, the brain stem (midbrain) 6, the cerebellum 7, the anastomosis, which forms a hole in the medial the wall of the cyst 8, the anastomosis, forming a hole in the wall of the side tank of the bridge 9, the remains of the trabeculae of the cyst 10.

 The inventive method differs from the prototype in that they connect the cavity of the arachnoid cyst and the side tank of the bridge. As a result of the formation of an anastomosis between the cavity of the arachnoid cyst and the cavity of the lateral cistern of the bridge, there are no conditions for the formation of a porcephalic cyst, there is no communication with the lumen of the lateral ventricle of the brain, which eliminates the risk of ventriculitis, damage to the conduction pathways of the brain and the occurrence of episindrome. The newly formed anastomosis allows the outflow of the contents of the cyst to the subarachnoid cistern of the brain, resulting in the expansion of the compressed areas of the brain with the subsequent disappearance of the cyst or a significant reduction in its size. Thus, the normal physiological circulation of the cerebrospinal fluid is restored.

 The method is as follows. Osteoplastic trepanation of the skull is performed in the right or left temporal region, depending on the location of the arachnoid cyst 1. The dura mater is dissected with a flap, the base of the sagittal sinus. Open the cavity of the cyst 1, evacuate its contents. Then, the outer wall of the cyst 1 is excised, i.e. its shell in the area where it is not connected with the substance of the brain. Further, intracystic septa and trabeculae are excised. After this, an anastomosis is made between the opened cavity of the arachnoid cyst and the lateral cistern of the bridge. This anastomosis is formed by two holes: the first in the medial wall of the arachnoid cyst 8 and the second, directly adjacent to the first, is made in the lateral wall of the lateral cistern of the bridge 9. The dimensions of these holes (2.5-3.0) • (0.5-1, 0) see. The dura mater is sutured tightly, the bone flap is laid in its place and fixed.

 The inventive method is developed and passed clinical trials at the Russian National Research Institute of Chemical Technology. prof. A.L. Polenova in the treatment of four patients in whom excellent results were obtained.

 We give an example extract from a medical history 1236.

 Patient B. aged 3 years and 6 months. During the examination for prolonged low-grade subfebrile condition of unknown etiology, a giant arachnoid cyst of the lateral cerebral fissure with dimensions of 8 • 6 • 5 cm with compression of the homolateral ventricle, right temporal lobe and a shift of the median structures by 6 mm to the left was revealed. Clinically, the disease was manifested by severe motor and speech disinhibition with bouts of aggressive behavior. According to the claimed method, on March 3, 1997, surgery was performed - osteoplastic trepanation of the skull in the right temporal region, excision of the cyst walls and drainage of its residual cavity into the lateral cistern of the bridge, by creating an anastomosis between the wall of the arachnoid cyst and the wall of the lateral cistern of the bridge. The postoperative period was uneventful. 6 months after surgery on the control MRI tomograms, the compression of previously compressed temporal and frontal lobes was noted. Clinically, a significant improvement in the condition of the child was noted. He became calm, balanced, affectionate, aggressiveness disappeared. He is currently studying in the first grade perfectly, there are no neurological disorders, the temporal and frontal lobes are completely straightened out, the cyst is not visualized on MRI tomograms.

 Using the proposed method allows for the restoration of normal physiological circulation of the cerebrospinal fluid, to avoid shunt dependence, to eliminate the compression of brain structures and to achieve expansion of the brain substance. Thus, the cyst disappears and the patient recovers.

Claims (1)

 A method for draining arachnoid cysts of the brain, including osteoplastic trepanation of the skull, dissection of the dura mater, excision of the walls of the arachnoid cyst, characterized in that they connect the cavity of the arachnoid cyst and the lateral cistern of the bridge.

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