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Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options

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Abstract

Purpose

A variety of surgical approaches for the treatment of pediatric intracranial arachnoid cysts exist. In an effort to identify the optimal surgical treatment for this disorder, we developed a decision analytic model to evaluate outcomes of four surgical approaches in children. These included open craniotomy for cyst excision, open craniotomy for cyst fenestration, endoscopic cyst fenestration, and cystoperitoneal shunting.

Methods

Pooled data were used to create evidence tables, from which we calculated incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) for the four surgical treatments. Our study incorporated data up to 5 years postsurgery.

Results

We analyzed 1,324 cases from 36 case series. There were no significant differences in outcome among the four surgical strategies. The QALYs (maximum of 5) for surgical approaches resulted in a range from 4.79 (for open craniotomy and excision) to 4.92 (for endoscopic fenestration).

Conclusions

Overall quality of life is comparable between patients undergoing open craniotomy for cyst excision or fenestration, endoscopic fenestration, and cystoperitoneal shunting up to 5 years after surgery. While each approach offers unique advantages and disadvantages, an individualized treatment strategy should be employed in the setting of surgical outcome equipoise.

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References

  1. Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO (2010) Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 5:578–585

    Article  PubMed  Google Scholar 

  2. Cincu R, Agrawal A, Eiras J (2007) Intracranial arachnoid cysts: current concepts and treatment alternatives. Clin Neurol Neurosurg 109:837–843

    Article  PubMed  Google Scholar 

  3. Robertson SJ, Wolpert SM, Runge VM (1989) MR imaging of middle cranial fossa arachnoid cysts: temporal lobe agenesis syndrome revisited. AJNR Am J Neuroradiol 10:1007–1010

    CAS  PubMed  Google Scholar 

  4. Kang JK, Lee KS, Lee IW, Jeun SS, Son BC, Jung CK, Park YS, Lee SW (2000) Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children. Childs Nerv Syst 16:111–116

    Article  CAS  PubMed  Google Scholar 

  5. Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8:281–286

    Article  CAS  PubMed  Google Scholar 

  6. Ciricillo SF, Cogen PH, Harsh GR, Edwards MS (1991) Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting. J Neurosurg 74:230–235

    Article  CAS  PubMed  Google Scholar 

  7. Dei-Anang K, Voth D (1989) Cerebral arachnoid cyst: a lesion of the child’s brain. Neurosurg Rev 12:59–62

    Article  CAS  PubMed  Google Scholar 

  8. Galassi E, Gaist G, Giuliani G, Pozzati E (1988) Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically. Acta Neurochir Suppl 42:201–204

    Article  CAS  PubMed  Google Scholar 

  9. Hanieh A, Simpson DA, North JB (1988) Arachnoid cysts: a critical review of 41 cases. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 4:92–96

    CAS  Google Scholar 

  10. Rappaport ZH (1993) Suprasellar arachnoid cysts: options in operative management. Acta Neurochir 122:71–75

    Article  CAS  PubMed  Google Scholar 

  11. Tamburrini G, Dal Fabbro M, Di Rocco C (2008) Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 24:593–604

    Article  Google Scholar 

  12. Einarson TR (1997) Pharmacoeconomic applications of meta-analysis for single groups using antifungal onychomycosis lacquers as an example. Clin Ther 19:559–569, discussion 538–559

    Article  CAS  PubMed  Google Scholar 

  13. King JT Jr, Berlin JA, Flamm ES (1994) Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis. J Neurosurg 81:837–842

    Article  PubMed  Google Scholar 

  14. von Neumann JMO (1944) Theory of games and economic behavior. Princeton University Press, Princeton

    Google Scholar 

  15. Thompson SG, Higgins JPT (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573

    Article  PubMed  Google Scholar 

  16. Sox HC, Blatt MA, Higgins MC, Marton KI (2007) Medical decision making. American College of Physicians, Philadelphia

    Google Scholar 

  17. Concato J, Feinstein AR (1997) Monte Carlo methods in clinical research: applications in multivariable analysis. J Investig Med Off Publ Am Fed Clin Res 45:394–400

    CAS  Google Scholar 

  18. Alexiou GA, Varela M, Sfakianos G, Prodromou N (2010) Shunting for the treatment of arachnoid cysts in children. Neurosurgery 67:1632–1636, discussion 1636

    Article  PubMed  Google Scholar 

  19. Arai H, Sato K, Wachi A, Okuda O, Takeda N (1996) Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery 39:1108–1112, discussion 1112–1103

    Article  CAS  PubMed  Google Scholar 

  20. Caldarelli M, Di Rocco C (1996) Surgical options in the treatment of interhemispheric arachnoid cysts. Surg Neurol 46:212–221

    Article  CAS  PubMed  Google Scholar 

  21. Choi JU, Kim DS, Huh R (1999) Endoscopic approach to arachnoid cyst. Childs Nerv Syst 15:285–291

    Article  CAS  PubMed  Google Scholar 

  22. Di Rocco F, James RS, Roujeau T, Puget S, Sainte-Rose C, Zerah M (2010) Limits of endoscopic treatment of sylvian arachnoid cysts in children. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 26:155–162

    Article  Google Scholar 

  23. El-Ghandour NM (2011) Endoscopic treatment of suprasellar arachnoid cysts in children. J Neurosurg Pediatr 8:6–14

    Article  PubMed  Google Scholar 

  24. El-Ghandour NM (2012) Endoscopic treatment of middle cranial fossa arachnoid cysts in children. J Neurosurg Pediatr 9:231–238

    Article  PubMed  Google Scholar 

  25. Ersahin Y, Kesikci H, Ruksen M, Aydin C, Mutluer S (2008) Endoscopic treatment of suprasellar arachnoid cysts. Childs Nerv Syst 24:1013–1020

    Article  PubMed  Google Scholar 

  26. Fewel ME, Levy ML, McComb JG (1996) Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 25:165–173

    Article  CAS  PubMed  Google Scholar 

  27. Galarza M, Pomata HB, Pueyrredon F, Bartuluchi M, Zuccaro GN, Monges JA (2002) Symptomatic supratentorial arachnoid cysts in children. Pediatr Neurol 27:180–185

    Article  PubMed  Google Scholar 

  28. Gui SB, Wang XS, Zong XY, Li CZ, Li B, Zhang YZ (2011) Assessment of endoscopic treatment for middle cranial fossa arachnoid cysts. Childs Nerv Syst 27:1121–1128

    Article  PubMed  Google Scholar 

  29. Helland CA, Wester K (2006) A population-based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in children. J Neurosurg 105:385–390

    Article  PubMed  Google Scholar 

  30. Kamikawa S, Inui A, Tamaki N, Kobayashi N, Yamadori T (2001) Application of flexible neuroendoscopes to intracerebroventricular arachnoid cysts in children: use of videoscopes. Minim Invasive Neurosurg 44:186–189

    Article  CAS  PubMed  Google Scholar 

  31. Karabagli H, Etus V (2012) Success of pure neuroendoscopic technique in the treatment of Sylvian arachnoid cysts in children. Childs Nerv Syst 28:445–452

    Article  PubMed  Google Scholar 

  32. Karabatsou K, Hayhurst C, Buxton N, O’Brien DF, Mallucci CL (2007) Endoscopic management of arachnoid cysts: an advancing technique. J Neurosurg 106:455–462

    Article  PubMed  Google Scholar 

  33. Levy ML, Wang M, Aryan HE, Yoo K, Meltzer H (2003) Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 53:1138–1144, discussion 1144–1135

    Article  PubMed  Google Scholar 

  34. Levy ML, Meltzer HS, Hughes S, Aryan HE, Yoo K, Amar AP (2004) Hydrocephalus in children with middle fossa arachnoid cysts. J Neurosurg 101:25–31

    Article  PubMed  Google Scholar 

  35. Maher CO, Goumnerova L (2011) The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts. J Neurosurg Pediatr 7:64–72

    Article  PubMed  Google Scholar 

  36. Mottolese C, Szathmari A, Simon E, Ginguene C, Ricci-Franchi AC, Hermier M (2010) The parallel use of endoscopic fenestration and a cystoperitoneal shunt with programmable valve to treat arachnoid cysts: experience and hypothesis. J Neurosurg Pediatr 5:408–414

    Article  PubMed  Google Scholar 

  37. Nowoslawska E, Polis L, Kaniewska D, Mikolajczyk W, Krawczyk J, Szymanski W, Zakrzewski K, Podciechowska J, Polis B (2006) Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods. Childs Nerv Syst 22:599–604

    Article  PubMed  Google Scholar 

  38. Pierre-Kahn A, Capelle L, Brauner R, Sainte-Rose C, Renier D, Rappaport R, Hirsch JF (1990) Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg 73:355–359

    Article  CAS  PubMed  Google Scholar 

  39. Sato H, Sato N, Katayama S, Tamaki N, Matsumoto S (1991) Effective shunt-independent treatment for primary middle fossa arachnoid cyst. Childs Nerv Syst 7:375–381

    Article  CAS  PubMed  Google Scholar 

  40. Shim KW, Lee YH, Park EK, Park YS, Choi JU, Kim DS (2009) Treatment option for arachnoid cysts. Childs Nerv Syst 25:1459–1466

    Article  PubMed  Google Scholar 

  41. Spacca B, Kandasamy J, Mallucci CL, Genitori L (2010) Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 26:163–172

    Article  Google Scholar 

  42. Turhan T, Ersahin Y, Akinturk N, Mutluer S (2012) Fenestration methods for Sylvian arachnoid cysts—endoscopy or microsurgery. Childs Nerv Syst 28:229–235

    Article  PubMed  Google Scholar 

  43. Zada G, Krieger MD, McNatt SA, Bowen I, McComb JG (2007) Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age. Neurosurg Focus 22:E1

    Article  PubMed  Google Scholar 

  44. Zhang B, Zhang Y, Ma Z (2012) Long-term results of cystoperitoneal shunt placement for the treatment of arachnoid cysts in children. J Neurosurg Pediatr 10:302–305

    Article  CAS  PubMed  Google Scholar 

  45. Oxford Centre for Evidence-Based Medicine (2013) Levels of evidence. http://www.cebm.net/index.aspx?o=1025. Accessed 30 Aug 2013

  46. Whitmore RG, Urban C, Church E, Ruckenstein M, Stein SC, Lee JY (2011) Decision analysis of treatment options for vestibular schwannoma. J Neurosurg 114:400–413

    Article  PubMed  Google Scholar 

  47. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC (2010) Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg 113:615–621

    Article  PubMed  Google Scholar 

  48. van de Graaf ES, van Kempen-du SH, Looman CW, Simonsz HJ (2010) Utility analysis of disability caused by amblyopia and/or strabismus in a population-based, historic cohort. Graefes Arch Clin Exp Ophthalmol 248:1803–1807

    Article  PubMed  PubMed Central  Google Scholar 

  49. Carroll AE, Downs SM (2009) Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. J Pediatr 155:21–25, 25 e21-25

    Article  PubMed  Google Scholar 

  50. Hatt SR, Leske DA, Holmes JM (2010) Responsiveness of health-related quality-of-life questionnaires in adults undergoing Strabismus surgery. Ophthalmology 117(2322–2328):e2321

    Google Scholar 

  51. Bohman LE, Stein SC, Newman JG, Palmer JN, Adappa ND, Khan A, Sitterley TT, Chang D, Lee JY (2012) Endoscopic versus open resection of tuberculum sellae meningiomas: a decision analysis. ORL J Otorhinolaryngol Relat Spec 74:255–263

    Article  PubMed  Google Scholar 

  52. Choux M, Raybaud C, Pinsard N, Hassoun J, Gambarelli D (1978) Intracranial supratentorial cysts in children excluding tumor and parasitic cysts. Childs Brain 4:15–32

    CAS  PubMed  Google Scholar 

  53. Sprung C, Mauersberger W (1979) Value of computed tomography for the diagnosis of arachnoid cysts and assessment of surgical treatment. Acta Neurochir Suppl 28:619–626

    CAS  PubMed  Google Scholar 

  54. Aoki N, Sakai T (1990) Intraoperative subdural hematoma in a patient with arachnoid cyst in the middle cranial fossa. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 6:44–46

    Article  CAS  Google Scholar 

  55. Chernov MF, Kamikawa S, Yamane F, Hori T (2004) Double-endoscopic approach for management of convexity arachnoid cyst: case report. Surg Neurol 61:483–486, discussion 486–487

    Article  PubMed  Google Scholar 

  56. Oertel JM, Baldauf J, Schroeder HW, Gaab MR (2009) Endoscopic cystoventriculostomy for treatment of paraxial arachnoid cysts. J Neurosurg 110:792–799

    Article  PubMed  Google Scholar 

  57. Tamburrini G, D’Angelo L, Paternoster G, Massimi L, Caldarelli M, Di Rocco C (2007) Endoscopic management of intra and paraventricular CSF cysts. Childs Nerv Syst 23:645–651

    Article  CAS  PubMed  Google Scholar 

  58. Raffel C, McComb JG (1988) To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients? Neurosurgery 23:338–342

    Article  CAS  PubMed  Google Scholar 

  59. Harsh GR, Edwards MS, Wilson CB (1986) Intracranial arachnoid cysts in children. Journal Neurosurg 64:835–842

    Article  Google Scholar 

  60. Kim SK, Cho BK, Chung YN, Kim HS, Wang KC (2002) Shunt dependency in shunted arachnoid cyst: a reason to avoid shunting. Pediatr Neurosurg 37:178–185

    Article  PubMed  Google Scholar 

  61. Paraskevopoulos D, Roth J, Beni-Adani L, Constantini S (2011) Interpeduncular arachnoid cysts in infants and children: insight into the entity based on a case series with long-term follow-up. Childs Nerv Syst 27:429–438

    Article  PubMed  Google Scholar 

  62. Kirollos RW, Javadpour M, May P, Mallucci C (2001) Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718

    Article  CAS  PubMed  Google Scholar 

  63. Buxton N, Vloeberghs M, Punt J (1999) Flexible neuroendoscopic treatment of suprasellar arachnoid cysts. Br J Neurosurg 13:316–318

    Article  CAS  PubMed  Google Scholar 

  64. Gangemi M, Colella G, Magro F, Maiuri F (2007) Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. British J Neurosurg 21:276–280

    Article  CAS  Google Scholar 

  65. Rizk E, Chern JJ, Tagayun C, Tubbs RS, Hankinson T, Rozzelle C, Oakes WJ, Blount JP, Wellons JC (2013) Institutional experience of endoscopic suprasellar arachnoid cyst fenestration. Childs Nerv Syst 29:1345–1347

    Article  PubMed  Google Scholar 

  66. Nomura M, Tachibana O, Hasegawa M, Kohda Y, Nakada M, Yamashima T, Yamashita J, Suzuki M (1996) Contrast-enhanced MRI of intrasellar arachnoid cysts: relationship between the pituitary gland and cyst. Neuroradiology 38:566–568

    Article  CAS  PubMed  Google Scholar 

  67. Shim KW, Park EK, Lee YH, Kim SH, Kim DS (2013) Transventricular endoscopic fenestration of intrasellar arachnoid cyst. Neurosurgery 72:520–528, discussion on 528

    Article  PubMed  Google Scholar 

  68. Crimmins DW, Pierre-Kahn A, Sainte-Rose C, Zerah M (2006) Treatment of suprasellar cysts and patient outcome. J Neurosurg 105:107–114

    PubMed  Google Scholar 

  69. Decq P, Brugieres P, Le Guerinel C, Djindjian M, Keravel Y, Nguyen JP (1996) Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696–701

    Article  CAS  PubMed  Google Scholar 

  70. Cinalli G, Spennato P, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, Cianciulli E, Maggi G (2007) Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23:633–644

    Article  PubMed  Google Scholar 

  71. Schroeder HW, Oertel J, Gaab MR (2004) Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst 20:878–883

    Article  PubMed  Google Scholar 

  72. Hopf NJ, Perneczky A (1998) Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43:1330–1336, discussion 1336–1337

    CAS  PubMed  Google Scholar 

  73. Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C (2003) Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 19:159–165

    CAS  Google Scholar 

  74. Elhammady MS, Bhatia S, Ragheb J (2007) Endoscopic fenestration of middle fossa arachnoid cysts: a technical description and case series. Pediatr Neurosurg 43:209–215

    Article  PubMed  Google Scholar 

  75. Greenfield JP, Souweidane MM (2005) Endoscopic management of intracranial cysts. Neurosurg Focus 19:E7

    Article  PubMed  Google Scholar 

  76. Elliott RE, Jane JA Jr, Wisoff JH (2011) Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 69:630–643, discussion 643

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank the following for collecting data from the Children’s Hospital of Philadelphia: Stephanie Huang BA, Alex Judd BA, Saida Kent BA, Jeong Kim BA, Ryan Faught BA, and Patrice Wood.

Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA

    Zarina S. Ali, Shih-Shan Lang, Dara Bakar, Phillip B. Storm & Sherman C. Stein

  2. Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Phillip B. Storm

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  1. Zarina S. Ali
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  2. Shih-Shan Lang
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  3. Dara Bakar
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  5. Sherman C. Stein
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Correspondence to Zarina S. Ali.

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Ali, Z.S., Lang, SS., Bakar, D. et al. Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options. Childs Nerv Syst 30, 461–469 (2014). https://doi.org/10.1007/s00381-013-2306-2

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