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Microsurgical fenestration and cystoperitoneal shunt through preauricular subtemporal keyhole craniotomy for the treatment of symptomatic middle fossa arachnoid cysts in children

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Abstract

Introduction

The optimal surgical treatment for symptomatic middle fossa arachnoid cyst is still controversial. The most leading therapeutic options include cyst shunting and fenestration (endoscopic, microsurgical). We present our experience on surgical treatments of arachnoid cysts.

Patients and methods

A retrospective data review of 16 children who underwent keyhole craniotomy for microsurgical fenestration and shunting of middle fossa arachnoid cysts between 1999 and 2012 was performed after institutional review board approval. The average patient age was 6.1 years. The average follow-up period was 36.5 months. There were ten male and six female patients in the series. Indications for surgery included intractable headaches (50 %), increasing in cyst size (18.75 %), and seizures (31.25 %). All patient records were reviewed for their clinical presentation, classification, cyst resolution, symptom resolution, and cyst outcomes. After surgery, all patients underwent assessments of clinical and radiological improvement.

Results

Postoperative complications were observed in two cases: progressively resolving monoparesia in one case and resolving epileptic seizure with monotherapy in the other. All patients had a satisfactory clinical outcome, and in 87.5 %, there was either a decrease in the size or a complete disappearance of the MFAC. Nevertheless, three (18.75 %) of all patients needed shunt revision because of shunt dysfunction. Complication related to surgical technique was cerebrospinal fluid leak which spontaneously resolved in one patient.

Conclusion

Microsurgical fenestration with keyhole craniotomy to provide passage between cysts to basal cisterns together with cystoperitoneal shunting during the same operation is still an effective and safe method in cases with symptomatic middle fossa arachnoid cysts in children.

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Authors and Affiliations

  1. Faculty of Medicine Department of Neurosurgery, Medipol University, İstanbul, Turkey

    Gökalp Silav, Ramazan Sarı, Fatih Han Bölükbaşı & İlhan Elmacı

  2. Faculty of Medicine, Department of Neurosurgery, Akdeniz University, Antalya, Turkey

    Murat Altaş

  3. Faculty of Medicine, Department of Neurosurgery, Medeniyet University, İstanbul, Turkey

    Nejat Işık

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  1. Gökalp Silav
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Silav, G., Sarı, R., Bölükbaşı, F.H. et al. Microsurgical fenestration and cystoperitoneal shunt through preauricular subtemporal keyhole craniotomy for the treatment of symptomatic middle fossa arachnoid cysts in children. Childs Nerv Syst 31, 87–93 (2015). https://doi.org/10.1007/s00381-014-2530-4

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