Abstract
Background
The management of Sylvian arachnoid cysts in children is still a matter of debate. Diagnosis is often incidental, and symptoms are frequently aspecific in symptomatic cases. Suggested diagnostic investigation results have been often unclear. Surgical treatment is also controversial, pure, and assisted endoscopic cyst marsupialization having entered in the traditional debate between craniotomic and shunting approach
Purpose
The objective of the present study was to survey if (and, eventually, which) agreement points do actually exist between internationally recognized pediatric neurosurgery centers in the management of children with a controversial type of Sylvian arachnoid cyst (Type II cyst).
Methods
Contributors were asked to answer to a six-separate-part multiple choice questionnaire related to the case of a 2.7-year-old boy with a Type II left Sylvian arachnoid cyst presented in different clinical situations. If surgery was indicated, it was asked which surgical procedure the authors would have suggested as first option.
Results and conclusions
The option of the mere clinical observation was chosen by the majority of surgeons in case of asymptomatic clinical discovery. On the other hand, a constantly high percentage of participants suggested direct surgical treatment based on clinical manifestations or as a preventive measure justified by the risk of spontaneous or traumatic intracranial bleeding. The only diagnostic investigation result which significantly influenced the surgical indication was a localizing electroencephalography, if the child presented with seizures. The result is that in most cases the surgical indication was based on aspecific clinical manifestations and laboratory data. Craniotomy and arachnoid cyst marsupialization represented the preferred surgical option (66.6%), 28.8% of the participants suggesting pure or assisted endoscopic cyst marsupialization as primary surgical procedure. Cyst shunting was suggested by only three centers.
Similar content being viewed by others
References
Aoki N, Sakai T, Umezawa Y (1990) Slit ventricle syndrome after cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst. Childs Nerv Syst 6(1):41–43
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(6):1108–1113
Arroyo S, Santamaria J (1997) What is the relationship between arachnoid cysts and seizure foci. Epilepsia 38(10):1098–1102
Beldzinska MM, Ostrowska ED (2002) Presentation of intracranial arachnoid cysts in children: correlation between localization and clinical symptoma. Med Sci Monit 8(6):462–465
Beltramello A, Mazza C (1985) Spontaneous disappearance of a large middle fossa arachnoid cyst. Surg Neurol 24(2):181–183
Choi JU, Kim DS, Huh R (1999) Endoscopic approach to arachnoid cyst. Childs Nerv Syst 15(6–7):285–291
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):633–644
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(2):230–235
De Volder AG, Michel C, Thauvoy C, Willems G, Ferriere G (1994) Brain glucose utilization in acquired childhood aphasia associated with a sylvian arachnoid cyst: recovery after shunting as demonstrated by PET. J Neurol Neurosurg Psychiatry 57(3):296–300
Di Rocco C (1996) Arachnoid cysts. In: Youmans JR (ed) Neurological surgery. Saunders, Philadelphia, pp 967–994
Di Rocco C, Tamburrini G, Caldarelli M, Velardi F, Santini P (2003) Prolonged ICP monitorino in sylvian arachnoid cysts. Surg Neurol 60:211–218
Eguchi T, Taoka T, Nikaido Y, Shiomi K, Fujimoto T, Otzuka H, Takeuchi H (1996) Cine-Magnetic Resonance Imaging evaluation of communication between middle cranial fossa arachnoid cysts and cisterns. Neurol Med Chir 36:353–357
Elhammady MS, Bhatia S, Ragheb J (2007) Endoscopic fenestration of middle fossa arachnoid cysts: a technical description and case series. Pediatr Neurosurg 43(3):209–215
Eskandary H, Sabba M, Khajehpour F, Eskandari M (2005) Incidental findings in brain computed tomography scans of 3,000 head trauma patients. Surg neurol 63(6):550–553
Fewel ME, Levy ML, McComb JG (1996) Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 25(4):165–173
Germanò A, Caruso G, Caffo M, Baldari S, Calisto A, Meli F, Tomasello F (2003) The treatment of large supratentorial arachnoid cysts in infants with cyst-peritoneal shunting and Hakim programmable valve. Childs Nerv Syst 19(3):166–173
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):839–841
Gosalakkal JA (2002) Intracranial arachnoid cysts in children: a review of pathogenesis, clinical features and management. Ped Neurol 26(2):93–98
Hamid N, Sgouros S (2005) The use off an adjustable valve to treat over-drainage of a cyst-peritoneal shunt in a child with a large sylvian fissure arachnoid cyst. Childs Nerv Syst 21(11):991–994
Helland CA, Wester K (2006) Arachnoid cysts in adults: long-term follow-up of patients treated with internal shunts to the subdural compartment. Surg Neurol 66(1):56–61
Helland CA, Wester K (2007) Intracystic pressure in patients with temporal arachnoid cysts: a prospective study of preoperative complaints and postoperative outcome. J Neurol Neurosurg Psychiatry 78(6):620–623
Hoffman KT, Hosten N, Meyer BU, Roricht S, Sprung X, Oellinger J, Guilbert M, Felix R (2000) CSF flow studies of intracranial cysts and cyst-like lesions achieved using reversed fast imaging with steady-state precession MR sequences. AJNR 21:493–502
Hopf NJ, Pernezski A (1998) Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43(6):1330–1336
Huang Q, Wang D, Guo Y, Zhou X, Wang X, Li X (2007) The diagnosis and neuroendoscopic treatment of noncommunicating intracranial arachnoid cysts. Surg Neurol 68(2):149–154
Hund-Georgiadis M, von Cramon Y, Kruggel F, Preul C (2002) Do quiescient arachnoid cysts alter CNS functional organization? A fMRI and morphometric study. Neurology 52(2):1935–1939
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(2):111–116
Karabatsu K, Hayhrust H, Buxton N, O’Brien DF, Mallucci CL (2007) Endoscopic management of arachnoid cysts: an advancing technique. J Neurosurg (Pdiatrics 6) 106:455–462
Kawamura T, Morioka T, Nishio S, Fukui K, Yamasaki R, Matsuo M (2002) Temporal lobe epilepsy associated with hippocampal sclerosis and a contralateral middle fossa arachnoid cyst. Seizure 11(1):60–62
Kim DS, Choi JU, Huh R, Yun PH, Kim DI (1999) Quantitative assessment of cerebrospinal fluid hydrodynamics using phase-contrast cine-MR in hydrocephalus. Childs Nerv Syst 15:461–467
Kim SK, Cho BK, Chung YN, Kim HS, Wang KC (2002) Shunt dependency in shunted arachnoid cyst: a reason to avoid ahunting. Pediatr Neurosurg 37(4):178–185
Kobayashi E, Bonilha L, Li LM, Cendes F (2003) Temporal lobe hypogenesis associated with arachnoid cyst in patients with epilepsy. Arq Neuropsiquiatr 61(2B):327–329
Koch CA, Voth D, Kraemer G, Schwarz M (1995) Arachnoid cysts: does surgery improve epileptic seizures and headaches. Neurosurg Rev 18(3):173–181
Koch CA, Moore JL, Voth D (1998) Arachnoid cysts: how do postsurgical cyst size and seizure outcome correlate. Neurosurg Rev 21(1):14–22
Kramer U, Nevo Y, Reider-Grosswasser I (1998) Neuroimaging of children with partial seizures. Seizure 7:115–118
Krupp W, Dohnert J, Kellermann S, Seifert V (1999) Intradiploic arachnoid cyst with extensive deformation of craniofacial osseous structures:case report. Neurosurgery 44:868–870
Kushen MC, Frim D (2007) Placement of subdural electrode grids for seizure focus localization in patients with a large arachnoid cyst. Technical note. Neurosurg Focus 22(2):E5
Lena G, Erdincler P, Van Calenbergh F, Genitori L, Choux M (1996) Arachnoid cysts of the middle cranial fossa in children. A review of 75 cases, 47 of which have been operated in a comparative study between membranectomy wit opening of cisterns and cystoperitoneal shunt. Neurochirurgie 42(1):29–34
Levy ML, Meltzer HS, Hughes S, Aryana HE, Yoo K, Amar AP (2004) Hydrocephalus in children with middle fossa arachnoid cysts. J Neurosurg (Pediatrics 2) 101:25–31
Levy ML, Wang M, Aryan HE, Yoo K, Meltzer H (2005) Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 56(5):E1166
Martinez-Lage JF, Valenti JA, Piqueras C, Ruiz-Espejo AM, Roman F, Nuno de la Rosa JA (2006) Functional assessment of intracranial arachnoid cysts with TC99 m-HMPAO SPECT: a preliminary report. Childs Nerv Syst 22:1091–1097
Mazurkiewicz-Beldzinska M, Dilling-Ostrowska E (2002) Presentation of intracranial arachnoid cysts in childrem: correlation between localization and clinical symptoms. Med Sci Monit 8(6):CR–462–CR-465
McDonald PJ, Rutka JT (1997) Middle cranial fossa arachnoid cysts that come and go. Report of two cases and review of the literature. Pediatr Neurosurg 26(1):48–52
Millichap JG (1997) Temporal lobe arachnoid cyst-attention deficit disorder syndrome: role of the EEG in diagnosis. Neurology 48(5):1435–1439
Morioka T, Nishio S, Ishibashi H, Fukui M (1998) What is the relationship between arachnoid cysts and seizure foci. Epilepsia 49(7):804–805 (Letter)
Mottolese C, Szathmari A, Di Somma L, Simon E, Ricci-Franchi AC, Cinguene C, Lak C, Vallee B (2007) Treatment of arachnoid cysts with endoscopic fenestration and shunting with programmable valve. Our experience. Childs Nerv Syst 23:1054–1055
Nowolawska E, Polis L, Kaniewska D, Mikolajczyk W, Krawczyk J, Szymanski W, Zakrewski K, Podciechowska J (2003) A comparison of neuroendoscopic techniques with other surgical procedures in the treatment of arachnoid cysts in children. Neurol Neurochir Pol 37(3):587–600
Nowolawska E, Polis L, Kaniewska D, Mikolajczyk W, Krawczyk J, Szymanski W, Zakrewski 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(6):599–604
Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8(5):281–286
Ozgur BM, Aryan HE, Levy ML (2005) Microsurgical keyhole middle fossa arachnoid cyst fenestration. J Clin Neurosci 12(7):804–806
Paladino J, Rotim K, Heinrich Z (1998) Neuroendoscopic fenestration of arachnoid cysts. Minim Invasive Neurosurg 41(3):137–140
Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K (1997) Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 40(3):483–490
Pradilla G, Jallo G (2007) Arachnoid cysts: case series and review of the literature. Neurosurg Focus 22(2):E7
Pulido-Rivas P, Villarejo-Ortega FJ, Cordobès-Tapia F, Pascual Martìn-Gamero A, Pèrez-Diaz C (2006) Surgical treatment of arachnoid cysts in children. Rev Neurol 42(6):383–384
Raeder MB, Helland CA, Hugdhal K, Wester K (2005) Arachnoid cysts cause cognitive deficits that improve after surgery. Neurology 64(1):60–62
Raffel C, McComb JG (1988) To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients. Neurosurgery 23(3):338–342
Rao G, Anderson RC, Feldstein NA, Brockmeyer DL (2005) Expansion of arachnoid cysts in children: report of two cases and review of the literature. J Neurosurg 102(3 Suppl):314–317
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(7):375–381
Schroeder HW, Gaav MR, Niendorf WR (1996) Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85(2):293–298
Sgouros S, Chapman S (2001) Congenital middle fossa arachnoid cysts may cause global brain ischaemia: a study with 99Tc-hexamethylpropyleneamineoxime single photon emission computerised tomography scans. Pediatr Neurosurg 35(4):188–194
Shigemori M, Okura A, Takahashi Y, Tokutomi T (1996) New surgical treatment of middle fossa arachnoid cyst. Surg Neurol 45(2):189–192
Sindou M, Guyotat-Pelissou I, Chidiac A, Goutelle A (1993) Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Experience with 75 cases. Acta neurochir 121(3–4):135–139
Sirkowski CW, Yamini B, Frim DM (2004) Endoscopic cyst fenestration outcomes in children one year of age or less. Pediatr Neurosurg 40(2):59–63
Stachura K, Czepko R (2006) Results of neuroendoscopic treatment of arachnoid cysts in adults. Neurol Neurochir Pol 40(5):391–396
Stowe LA, Go KG, Pruim J, den Dunnen W, Meiners LC, Paans AM (2000) Language localization in cases of left temporal arachnoid cyst: evidence against interhemispheric rorganization. Brain Lang 75(3):347–358
Sunami K, Saeki N, Sunada S, Hoshi S, Murai H, Kubota M, Takanashi J, Yamaura A (2002) Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children—a clinical entity difficult to detect on neuroimaging study. Brain Dev 24(8):776–779
Sztriha L, Guruaj A (2005) Hippocampal dysgenesis associated with temporal lobe hypoplasia and arachnoid cyst of the middle cranial fossa. J Child Neurol 20(11):926–930
Tamburrini G, Caldarelli M, Massimi L, Di Giuda M, Novegno F, Di Rocco F, Di Rocco C (2005) Prolonged ICP monitoring combined with SPECT studies in children with sylvian fissure arachnoid cysts. Childs Nerv Syst 21:840
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):159–165
Tamburrini G, Di Rocco C, Velardi F, Santini P (2004) Prolonged intracranial pressure (ICP) monitoring in non-traumatic pediatric neurosurgical diseases. Med Sci Monit 10:MT53–MT63
Wang PJ, Lin HC, Liu HM, Tseng CL, Shen YZ (1998) Intracranial arachnoid cysts in children: related signs and associated anomalies. Pediatr Neurol 19(2):100–104
Weber R, Voit T, Lumenta C, Lenard HG (1991) Spontaneous regression of a temporal arachnoid cyst. Childs Nerv Syst 7(7):414–415
Wester K (1999) Peculiarities of intracranial arachnoid cysts: location sidedness and sex distribution in 126 consecutive patients. Neurosurgery 45(4):775–779
Wester K, Helland CA (2008) How often do chronic extra-cerebral haematomas occur in patients with intracranial arachnoid cysts? J Neurol Neurosurg Psychiatry 79(1):72–75
Wester K, Hugdhal K (1995) Arachnoid cysts of the temporal fossa: impaired preoperative cognition and postoperative improvement. J Neurol Neurosurg Psych 59:293–298
Yalcin DA, Oncel C, Kaymaz A, Kuolu N, Forta H (2002) Evidence against association between arachnoid cysts and epilepsy. Ep Res 49(3):255–260
Yamauchi T, Saeki N, Yamaura A (1999) Spontaneous disappearence of temporo-frontal arachnoid cyst in a child. Acta Neurochir 141(5):537–540
Yildiz H, Erdogan C, Yalcin R, Yazici Z, Hakyemez B, Parlak M, Tuncel E (2005) Evaluation of communication between intracranial arachnoid cysts and cisterns with phase-contrast cine MR imaging. AJNR 26:145–151
Yildiz H, Yazici Z, Hakyemez B, Erdogan C, Parlak M (2006) Evaluation of CSF flow patterns of posterior fossa cystic malformations using CSF flow MR imaging. Neuroradiology 48:595–605
Zaatreh MM, Bates E, Hooper SR, Palmer G, Elmenshawi EE, Courvoisie HE, Greenwood RS (2002) Morphometric and neuropsychologic studies in children with arachnoid cysts. Ped Neurol 26(2):134–138
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):E1
Acknowledgements
The authors warmly thank all the participants to the survey, named below in alphabetical order: N. Akalan (Ankara, Turkey), M.K. Baykaner (Ankara, Turkey), F. Boop (Memphis, TN, USA), J.U. Choi (Seoul, Korea), G. Cinalli (Naples, Italy), S. Constantini (Tel-Aviv, Israel), M. D. Fabbro (Campinas, Brazil), C. Deopujiari (Bombay, India), H. Eder (Graz, Austria), E. Galassi (Bologna, Italy), U. Godano (Cagliari, Italy), R. Hayward (London, UK), J. Hinojosa (Madrid, Spain), SK Hwang (Daegu, Korea), A. Iannelli (Pisa, Italy), R. Kumar (Lucknow, India), A. Mahapatra (New Delhi, India), W. Maixner (Melbourne, Australia), C. Mallucci (Liverpool, UK), J.F. Martinez-Lage (Murcia, Spain), H. Matsushita (Sao Paulo, Brazil), C. Mazza (Verona, Italy), G. McComb (Los Angeles, CA, USA), M. Messing-Junger (Sankt Augustin, Bonn, Germany), N. Morota (Tokyo, Japan), M. Ozek (Istanbul, Turkey), T.S. Park (St. Louis, MO, USA), H. Rekate (Phoenix, AZ, USA), B. Rilliet (Lausanne, Switzerland), J. Ruge (Chicago, IL, USA), J.F.M. Salomao (Rio de Janeiro, Brazil), M. Scott (Boston, USA), W.T. Seow (Singapore), W. Serlo (Oulu, Finland), C. Teo (Sidney, Australia), L. Valentini (Milan, Italy), S. Valenzuela (Santiago, Chile), F. Van Calenbergh (Leuven, Belgium), F. Velardi (Rome, Italy), E. Ventureyra (Ottawa, Canada), M. Vinchon (Lille, France), W. Wagner (Mainz, Germany), T.T. Wong (Taipei, Taiwan), Y. Yamanouchi (Osaka, Japan), G. Zuccaro (Buenos Aires, Argentina).
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s00381-008-0639-z
Rights and permissions
About this article
Cite this article
Tamburrini, G., Del Fabbro, M. & Di Rocco, C. Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management. Childs Nerv Syst 24, 593–604 (2008). https://doi.org/10.1007/s00381-008-0585-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-008-0585-9