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Child's Nervous System

, Volume 28, Issue 3, pp 445–452 | Cite as

Success of pure neuroendoscopic technique in the treatment of Sylvian arachnoid cysts in children

  • Hakan KarabagliEmail author
  • Volkan Etus
Original Paper

Abstract

Introduction

Neuroendoscopic approaches to Sylvian arachnoid cysts (SACs) constitute an alternative treatment option to craniotomy for fenestration and shunting procedures. In this study, the authors discuss their experience on pure neuroendoscopic technique in the treatment of SACs in children.

Results

The results of treatment of 20 children (range of age, between 7 months and 17 years) with Galassi type II (n, 5) or III (n, 15) SACs who were subjected to pure neuroendoscopic fenestration procedure were presented. It was possible to perform the cystocisternostomy endoscopically in all children with several stomies. The site of the opening was between the optic nerve and the carotid artery in 19, between the carotid artery and the oculomotor nerve in 17, and below the oculomotor nerve in 7. The stomies were enlarged in all cases using the double balloon. Three of the cases required repetition of the operation and two cases required “cystoperitoneal shunt” implantation. There was one minor complication in a patient who had an asymptomatic postoperative subdural effusion, which resolved spontaneously. Of the 18 cases, in which the neuroendoscopic procedures succeeded, 10 showed a reduction in cyst size. The mean follow-up period was 53 months.

Discussion

Our results suggest that “pure neuroendoscopic” approach can be used safely in the management of SACs in children. We recommend at least two fenestration sites for an effective marsupialization of the cyst within the basal cisterns. In pediatric cases, the use of a small diameter rigid endoscope allows to reach safely the planned target areas.

Keywords

Arachnoid cyst Children Endoscopy Sylvian Technique 

References

  1. 1.
    Balsubramaniam C, Laurent J, Rouah E, Armstrong D, Feldstein N, Schneider S, Cheek W (1989) Congenital arachnoid cysts in children. Pediatr Neurosci 15:223–228PubMedCrossRefGoogle Scholar
  2. 2.
    Beems T, Grotenhuis JA (2004) Long-term complications and definition of failure of neuroendoscopic procedures. Childs Nerv Syst 20(11–12):868–877PubMedCrossRefGoogle Scholar
  3. 3.
    Bright R (1831) Reports of medical cases selected with a view of illustrating the symptoms and cure of diseases by a reference to morbid anatomy. In: Longman, Rees, Orme et al (eds) Diseases of the brain and nervous system, vol 2. Highley, London, pp 593–660Google Scholar
  4. 4.
    Choi JU, Kim DS, Huh R (1999) Endoscopic approach to arachnoid cyst. Childs Nerv Syst 15(6–7):285–291PubMedCrossRefGoogle Scholar
  5. 5.
    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(6):633–644PubMedCrossRefGoogle Scholar
  6. 6.
    Di Rocco C (2010) Sylvian fissure arachnoid cysts: we do operate on them but should it be done? Childs Nerv Syst 26:173–175PubMedCrossRefGoogle Scholar
  7. 7.
    Di Rocco C, Caldarelli M, Ceddia A (1993) Incidence, anatomical distribution, and classification of arachnoidal cysts. In: Raimondi A, Choux M, Di Rocco C (eds) Intracranial cyst lesions. Springer, New York, pp 101–111Google Scholar
  8. 8.
    Di Rocco F, James SR, Roujeau T, Puget S, Sainte-Rose C, Zerah M (2010) Limits of endoscopic treatment of Sylvian arachnoid cysts in children. Childs Nerv Syst 26:155–162PubMedCrossRefGoogle Scholar
  9. 9.
    Elhammady MS, Bhatia S, Ragheb J (2007) Endoscopic fenestration of middle fossa arachnoid cysts: a technical description and case series. Pediatr Neurosurg 43(3):209–215PubMedCrossRefGoogle Scholar
  10. 10.
    Godano U, Mascari C, Consales A, Calbucci F (2004) Endoscope-controlled microneurosurgery for the treatment of intracranial fluid cysts. Childs Nerv Syst 20(11, 12):839–841PubMedCrossRefGoogle Scholar
  11. 11.
    Greenfield JP, Souweidane MM (2005) Endoscopic management of intracranial cysts. Neurosurg Focus 19(6):E7PubMedCrossRefGoogle Scholar
  12. 12.
    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 105:385–390PubMedCrossRefGoogle Scholar
  13. 13.
    Hopf NJ, Pernezski A (1998) Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43(6):1330–1336PubMedGoogle Scholar
  14. 14.
    Kang JK, Lee KS, Lee IW, Jeun SS, Son BC, Jung CK, Park YS, Lee SW (2000) Shunt-independent surgical treatment of middle fossa arachnoid cysts in children. Childs Nerv Syst 16:111–116PubMedCrossRefGoogle Scholar
  15. 15.
    Karabatsu K, Hayhurst H, Buxton N, O’Brien DF, Mallucci CL (2007) Endoscopic management of arachnoid cysts: an advancing technique. J Neurosurg 106:455–462CrossRefGoogle Scholar
  16. 16.
    Levy ML, Wang M, Aryan HE, Yoo K, Meltzer H (2003) Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 53(5):1138–1144PubMedCrossRefGoogle Scholar
  17. 17.
    Passero S, Filosomi G, Cioni R, Venturi V, Volpini B (1990) Arachnoid cysts of the middle cranial fossa: a clinical, radiological and followup study. Acta Neurol Scand 82:94–100PubMedCrossRefGoogle Scholar
  18. 18.
    Rengachary S, Watanabe T (1981) Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:616–663Google Scholar
  19. 19.
    Santamarta D, Aguas J, Ferrer E (1995) The natural history of arachnoid cysts: endoscope and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 38:133–137PubMedCrossRefGoogle Scholar
  20. 20.
    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 26:163–172PubMedCrossRefGoogle Scholar
  21. 21.
    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 19(3):159–165PubMedGoogle Scholar
  22. 22.
    Tamburrini G, Fabbro MD, Di Rocco C (2008) Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management. Childs Nerv Syst 24:593–604PubMedCrossRefGoogle Scholar
  23. 23.
    Wester K, Hugdhal K (1995) Arachnoid cysts of the temporal fossa: impaired preoperative cognition and postoperative improvement. J Neurol Neurosurg Psychiatry 59:293–298PubMedCrossRefGoogle Scholar
  24. 24.
    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(2):E1PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Neurosurgery, Selcuklu Faculty of MedicineSelcuk UniversityKonyaTurkey
  2. 2.Department of Neurosurgery, Faculty of MedicineKocaeli UniversityKocaeliTurkey

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