儿童四叠体池蛛网膜囊肿临床特点及疗效分析：一项定量回顾性研究

doi:10.3969/j.issn.1674-8115.2026.01.008

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (1): 66-74.doi: 10.3969/j.issn.1674-8115.2026.01.008

儿童四叠体池蛛网膜囊肿临床特点及疗效分析：一项定量回顾性研究

刘美伶¹, 包磊², 闵令钊¹, 魏嘉¹, 华丽³, 王晓强¹()

^1.上海交通大学医学院附属新华医院儿神经外科，上海 200092
^2.上海交通大学医学院附属新华医院放射科，上海 200092
^3.上海交通大学公共卫生学院流行病学与生物统计学系，上海 200025

收稿日期:2025-09-28 接受日期:2025-11-18 出版日期:2026-01-28 发布日期:2026-01-30
通讯作者: 王晓强，主任医师，博士；电子信箱：wangxiaoqiang@xinhuamed.com.cn。
作者简介:第一联系人：刘美伶负责整理文献、撰写论文、调整版面，包磊进行影像学数据收集，闵令钊完成临床数据收集，魏嘉参与论文修改和校正，华丽提供统计学分析指导，王晓强负责论文总体概念和框架设计、论文审阅。所有作者均阅读并同意最终稿件的提交。
基金资助:
无锡市儿童医院专家引领项目（2025）新华医院王晓强专家团队经费(2025XHYY-WXQ)

Clinical characteristics and surgical outcome analysis of quadrigeminal cistern arachnoid cysts in children: a quantitative retrospective cohort study

Liu Meiling¹, Bao Lei², Min Lingzhao¹, Wei Jia¹, Hua Li³, Wang Xiaoqiang¹()

^1.Department of Pediatric Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
^2.Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
^3.Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China

Received:2025-09-28 Accepted:2025-11-18 Online:2026-01-28 Published:2026-01-30
Contact: Wang Xiaoqiang, E-mail: wangxiaoqiang@xinhuamed.com.cn.
About author:First author contact:Liu Meiling was responsible for literature review, manuscript drafting, and formatting. Bao Lei collected the imaging data. Min Lingzhao completed the collection of clinical data. Wei Jia participated in manuscript revision and proofreading. Hua Li provided guidance on statistical analysis. Wang Xiaoqiang oversaw the overall conception and design of the manuscript, as well as its critical review. All authors have read the final version of the paper and consented to its submission.
Supported by:
Wuxi Children′s Hospital Expert-led Project (2025): Funding for Wang Xiaoqiang′s Team, Xinhua Hospital(2025XHYY-WXQ)

摘要/Abstract

摘要：

目的·在量化四叠体池蛛网膜囊肿（quadrigeminal cistern arachnoid cyst，QAC）体积和脑积水的基础上，初步分析儿童QAC的临床特点和不同术式的疗效，以期提高对该疾病的认知和诊治水平。方法·选择上海交通大学医学院附属新华医院2015年1月至2025年6月期间收治的27例QAC患儿，通过头颅磁共振成像（magnetic resonance imaging，MRI）和计算机断层扫描（computed tomography，CT）检查计算QAC体积和Evans指数，回顾分析其一般资料、症状体征、影像学表现、手术情况和预后情况。结果·27例患儿年龄分布0 d~150个月，男女人数比为1.08∶1，术前QAC中位体积为34 402 （15 022，138 478）mm³，中位Evans指数为0.29（0.24，0.48）。其中12例患者无症状，多在6月龄以下；15例存在颅内压增高、抽搐、肌力下降或瞬目频繁等症状，多在6月龄以上。27例患者共进行了33次手术，其中1次手术22例，2次手术4例，3次手术1例。内镜下开窗造瘘术（endoscopic fenestration，EF）、EF联合内镜下第三脑室底造瘘术（endoscopic third ventriculostomy，ETV）、脑室腹腔分流术（ventriculoperitoneal shunt，VP）的再手术率依次为15.8%、40.0%和0。总再手术率为18.5%，其中6月龄以下的患儿行多次手术的概率更高。27例患儿随访3个月~10年，88.9%的患儿术后3个月QAC体积明显变小，92.3%的患儿临床表现明显好转。未发现EF、EF+ETV及VP手术之间存在疗效差异。术后12个月和24个月的QAC体积变化及Evans指数变化具有一定差异，术前QAC体积≥50 000 mm³的患儿上述指标更倾向于变小。结论·QAC的发生几乎无性别差异，可以肌力下降和瞬目频繁为首发症状。年龄和症状之间可能具有一定相关性。QAC再手术率较低，手术疗效显著，术后短期QAC体积明显缩小，症状多消失或改善。暂未发现EF、EF+ETV和VP手术之间具有疗效差异，术前QAC体积较大的患儿长期预后可能更好。

关键词: 四叠体池蛛网膜囊肿, 定量研究, 临床表现, 治疗效果, 儿童

Abstract:

Objective ·To quantify the volume of quadrigeminal cistern arachnoid cysts (QACs) and hydrocephalus indicators, and analyze the clinical features of QACs in children and the efficacy of different surgical techniques, with the goal of improving understanding, diagnosis, and treatment of this condition. Methods ·A retrospective analysis was conducted on 27 pediatric patients with QACs treated at Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, between January 2015 and June 2025. The volume of QACs and the Evans index were calculated by using cranial magnetic resonance imaging (MRI) and computed tomography (CT). Clinical data, including demographics, symptoms/signs, imaging findings, surgical procedures, and follow-up outcomes, were reviewed. Results ·The cohort (age range: 0 d‒150 months; male-to-female ratio: 1.08∶1) had a median preoperative QAC volume of 34 402 (15 022, 138 478) mm³ and a median Evans index of 0.29 (0.24, 0.48). Among the cases, twelve were asymptomatic and were predominantly infants under 6 months of age, whereas fifteen symptomatic cases—presenting with intracranial hypertension, seizures, limb weakness, or frequent blinking—were mostly older than 6 months. A total of 33 surgeries were performed (one surgery: 22 cases; two surgeries: 4 cases; three surgeries: 1 case). Reoperation rates were 15.8% for endoscopic fenestration (EF), 40.0% for EF combined with endoscopic third ventriculostomy (ETV), and 0 for ventriculoperitoneal shunt (VP). The overall reoperation rate was 18.5%, with infants under 6 months having a higher probability of requiring repeat surgeries. During follow-up, 88.9% of patients showed significant QAC volume reduction at 3 months postoperatively, and 92.3% exhibited clinical improvement. No efficacy differences were found among EF, EF+ETV, and VP procedures to date. Patients with larger preoperative QACs (≥50 000 mm³) showed more pronounced reductions in QAC volume and Evans index at 12 and 24 months postoperatively. Conclusion ·QACs exhibit no gender predilection and may present with limb weakness or frequent blinking as initial symptoms. Age and symptoms may be correlated. Surgical outcomes are favorable, with low reoperation rates, significant short-term volume reduction, and symptom resolution. No difference in efficacy is observed among EF, EF+ETV, and VP procedures. Larger QACs are associated with a better long-term prognosis.

Key words: quadrigeminal cistern arachnoid cyst (QAC), quantitative analysis, clinical manifestation, surgical outcome, child

中图分类号:

R726

刘美伶, 包磊, 闵令钊, 魏嘉, 华丽, 王晓强. 儿童四叠体池蛛网膜囊肿临床特点及疗效分析：一项定量回顾性研究[J]. 上海交通大学学报（医学版）, 2026, 46(1): 66-74.

Liu Meiling, Bao Lei, Min Lingzhao, Wei Jia, Hua Li, Wang Xiaoqiang. Clinical characteristics and surgical outcome analysis of quadrigeminal cistern arachnoid cysts in children: a quantitative retrospective cohort study[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 66-74.

图/表 5

参考文献 13

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Item	Total (n=27)	≤6 month (n=12)	>6 month (n=15)	P value
Age of diagnosis/month	0 (0, 47)	0 (0, 0)	35 (7, 112)	0.002
Age of treatment/month	12 (5, 48)	5 (3, 6)	36 (13, 112)	0.001
Gender/n(%)				1.000
Female	13 (48.1)	6 (50.0)	7 (46.7)
Male	14 (51.9)	6 (50.0)	8 (53.3)
Symptom/n(%)				0.014
Yes	15 (55.6)	3 (25.0)	12 (80.0)
No	12 (44.4)	9 (75.0)	3 (20.0)
Number of QAC/n(%)				0.745
1	14 (51.9)	6 (50.0)	8 (53.3)
2	10 (37.0)	4 (33.3)	6 (40.0)
3	3 (11.1)	2 (16.7)	1 (6.7)
Location of QAC/n(%)				1.000
Inside the quadrigeminal cistern	10 (37.0)	4 (33.3)	6 (40.0)
Outside the quadrigeminal cistern	17 (63.0)	8 (66.7)	9 (60.0)
Number of surgery/n(%)				0.010
1	22 (81.5)	7 (58.3)	15 (100.0)
2	4 (14.8)	4 (33.3)	0 (0.0)
3	1 (3.7)	1 (8.3)	0 (0.0)
Hydrocephaly/n(%)				0.363
Yes	12 (44.4)	7 (58.3)	5 (33.3)
No	15 (55.6)	5 (41.7)	10 (66.7)
Preoperative volume of QAC/n(%)				0.239
<50 000 mm³	16 (59.3)	9 (75.0)	7 (46.7)
≥50 000 mm³	11 (40.7)	3 (25.0)	8 (53.3)
Preoperative volume of QAC/mm³	34 402 (15 022, 138 478)	33 929 (15 385, 71 125)	66 260 (14 314, 146 140)	0.411
Preoperative Evans/n(%)	0.29 (0.24, 0.48)	0.30 (0.24, 0.48)	0.27 (0.24, 0.46)	0.719

Item	Total (n=27)	≤6 month (n=12)	>6 month (n=15)	P value
Age of diagnosis/month	0 (0, 47)	0 (0, 0)	35 (7, 112)	0.002
Age of treatment/month	12 (5, 48)	5 (3, 6)	36 (13, 112)	0.001
Gender/n(%)				1.000
Female	13 (48.1)	6 (50.0)	7 (46.7)
Male	14 (51.9)	6 (50.0)	8 (53.3)
Symptom/n(%)				0.014
Yes	15 (55.6)	3 (25.0)	12 (80.0)
No	12 (44.4)	9 (75.0)	3 (20.0)
Number of QAC/n(%)				0.745
1	14 (51.9)	6 (50.0)	8 (53.3)
2	10 (37.0)	4 (33.3)	6 (40.0)
3	3 (11.1)	2 (16.7)	1 (6.7)
Location of QAC/n(%)				1.000
Inside the quadrigeminal cistern	10 (37.0)	4 (33.3)	6 (40.0)
Outside the quadrigeminal cistern	17 (63.0)	8 (66.7)	9 (60.0)
Number of surgery/n(%)				0.010
1	22 (81.5)	7 (58.3)	15 (100.0)
2	4 (14.8)	4 (33.3)	0 (0.0)
3	1 (3.7)	1 (8.3)	0 (0.0)
Hydrocephaly/n(%)				0.363
Yes	12 (44.4)	7 (58.3)	5 (33.3)
No	15 (55.6)	5 (41.7)	10 (66.7)
Preoperative volume of QAC/n(%)				0.239
<50 000 mm³	16 (59.3)	9 (75.0)	7 (46.7)
≥50 000 mm³	11 (40.7)	3 (25.0)	8 (53.3)
Preoperative volume of QAC/mm³	34 402 (15 022, 138 478)	33 929 (15 385, 71 125)	66 260 (14 314, 146 140)	0.411
Preoperative Evans/n(%)	0.29 (0.24, 0.48)	0.30 (0.24, 0.48)	0.27 (0.24, 0.46)	0.719

Item	Total	EF	EF+ETV	VP	P value
Evans index change at 3 months postoperatively/n(%)					0.477
Decreased	14 (51.9)	8 (42.1)	3 (60.0)	3 (100)
Increased	9 (33.3)	7 (36.8)	2 (40.0)	0 (0)
Unchanged	4 (14.8)	4 (21.1)	0 (0)	0 (0)
Evans index change at 12 months postoperatively/n(%)					0.515
Decreased	6 (37.5)	3 (25.0)	1 (50.0)	2 (100)
Increased	7 (43.8)	6 (50.0)	1 (50.0)	0 (0)
Unchanged	3 (18.7)	3 (25.0)	0 (0)	0 (0)
Evans index change at 24 months postoperatively/n(%)					0.105
Decreased	6 (60.0)	2 (33.3)	1 (100)	3 (100)
Increased	4 (40.0)	4 (66.7)	0 (0)	0 (0)
Cyst volume change at 3 months postoperatively/n(%)					0.376
Shrunken	24 (88.9)	17 (89.5)	5 (100)	2 (66.7)
Enlarging	3 (11.1)	2 (10.5)	0 (0)	1 (33.3)
Cyst volume change at 12 months postoperatively/n(%)					0.245
Shrunken	12 (75.0)	10 (83.3)	1 (50.0)	1 (50.0)
Enlarging	4 (25.0)	2 (16.7)	1 (50.0)	1 (50.0)
Cyst volume change at 24 months postoperatively/n(%)					1.000
Shrunken	7 (70.0)	4 (66.7)	1 (100)	2 (66.7)
Enlarging	3 (30.0)	2 (33.3)	0 (0)	1 (33.3)
Postoperative complications/n(%)					1.000
Yes	7 (25.9)	5 (26.3)	1 (20.0)	1 (33.3)
No	20 (74.1)	14 (73.7)	4 (80.0)	2 (66.7)

Item	Total	EF	EF+ETV	VP	P value
Evans index change at 3 months postoperatively/n(%)					0.477
Decreased	14 (51.9)	8 (42.1)	3 (60.0)	3 (100)
Increased	9 (33.3)	7 (36.8)	2 (40.0)	0 (0)
Unchanged	4 (14.8)	4 (21.1)	0 (0)	0 (0)
Evans index change at 12 months postoperatively/n(%)					0.515
Decreased	6 (37.5)	3 (25.0)	1 (50.0)	2 (100)
Increased	7 (43.8)	6 (50.0)	1 (50.0)	0 (0)
Unchanged	3 (18.7)	3 (25.0)	0 (0)	0 (0)
Evans index change at 24 months postoperatively/n(%)					0.105
Decreased	6 (60.0)	2 (33.3)	1 (100)	3 (100)
Increased	4 (40.0)	4 (66.7)	0 (0)	0 (0)
Cyst volume change at 3 months postoperatively/n(%)					0.376
Shrunken	24 (88.9)	17 (89.5)	5 (100)	2 (66.7)
Enlarging	3 (11.1)	2 (10.5)	0 (0)	1 (33.3)
Cyst volume change at 12 months postoperatively/n(%)					0.245
Shrunken	12 (75.0)	10 (83.3)	1 (50.0)	1 (50.0)
Enlarging	4 (25.0)	2 (16.7)	1 (50.0)	1 (50.0)
Cyst volume change at 24 months postoperatively/n(%)					1.000
Shrunken	7 (70.0)	4 (66.7)	1 (100)	2 (66.7)
Enlarging	3 (30.0)	2 (33.3)	0 (0)	1 (33.3)
Postoperative complications/n(%)					1.000
Yes	7 (25.9)	5 (26.3)	1 (20.0)	1 (33.3)
No	20 (74.1)	14 (73.7)	4 (80.0)	2 (66.7)

Item	Preoperative	At 3 months postoperatively			At 12 months postoperatively			At 24 months postoperatively
Item	Preoperative	Value	t value	P value	Value	t value	P value	Value	t value	P value
Evans index	0.29 (0.24, 0.48)	0.28 (0.24, 0.44)	0.319	0.751	0.28 (0.25, 0.41)	0.459	0.649	0.33±0.09	0.422	0.677
QAC volume/mm³	33 456 (15 022, 138 478)	16 982 (9 166, 66 872)	3.580	0.001	29 020 (11 646, 63 938)	1.551	0.129	62 669±48 573	0.549	0.588
Evans index change rate	‒	0.03±0.08	1.889	0.070	0 (-0.04, 0.14)	-0.399	0.696	0.09 (-0.04, 0.26)	-0.256	0.804
QAC volume change rate	‒	0.36 (0.15, 0.50)	2.947	0.007	0.26 (-0.02, 0.60)	0.024	0.981	0.22 (-0.21, 0.31)	-0.459	0.657

儿童四叠体池蛛网膜囊肿临床特点及疗效分析：一项定量回顾性研究

Clinical characteristics and surgical outcome analysis of quadrigeminal cistern arachnoid cysts in children: a quantitative retrospective cohort study

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参考文献 13

相关文章 15

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Metrics

Item	All	<50 000 mm³	≥50 000 mm³	P value
Evans
Preoperative	0.29 (0.24, 0.48)	0.25 (0.24, 0.29)	0.48 (0.30, 0.54)	0.009
At 3 months postoperatively	0.28 (0.24, 0.44)	0.26 (0.22, 0.29)	0.44 (0.28, 0.50)	0.011
At 12 months postoperatively	0.28 (0.25, 0.41)	0.28 (0.25, 0.32)	0.33 (0.24, 0.42)	0.870
At 24 months postoperatively	0.33±0.09	0.34±0.11	0.32±0.07	0.688
Volume of QAC
Preoperative	33 456 (15 022, 138 478)	16 706 (11 885, 28 935)	152 793 (136 120, 162 238)	<0.001
At 3 months postoperatively	16 982 (9 166, 66 872)	11 624 (7 407, 16 416)	103 000 (59 706, 127 387)	<0.001
At 12 months postoperatively	29 020 (11 646, 63 938)	17 594 (10 686, 47 258)	66155 (26 529, 132 130)	0.193
At 24 months postoperatively	62 669±48 573	41 521±23 453	83 818±60 335	0.202
Evans change rate
At 3 months postoperatively	0.03±0.08	0.02±0.07	0.05±0.10	0.407
At 12 months postoperatively	0 (-0.04, 0.14)	-0.04 (-0.16, -0.01)	0.15 (0.08, 0.18)	0.003
At 24 months postoperatively	0.09 (-0.04, 0.26)	-0.04 (-0.40, -0.03)	0.26 (0.26, 0.31)	0.016
Volume change rate
At 3 months postoperatively	0.36 (0.15, 0.50)	0.33 (0.10, 0.51)	0.36 (0.20, 0.48)	0.657
At 12 months postoperatively	0.26 (-0.02, 0.60)	0.11 (-0.34, 0.30)	0.49 (0.26, 0.81)	0.104
At 24 months postoperatively	0.22 (-0.21, 0.31)	-0.29 (-0.37, 0.04)	0.32 (0.26, 0.77)	0.028

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