Abstract
Objective
Although middle fossa arachnoid cysts (MFACs) are common, the optimal surgical treatment for these lesions remains controversial. In this study, we present our experiences of treating MFACs by microsurgical fenestration and evaluate its effectiveness.
Methods
We performed retrospective review of 28 patients who underwent microsurgical fenestration for MFACs between May 2003 and December 2014. We reviewed patient characteristics and treatment outcomes including age, sex, symptoms, complicating hydrocephalus, Gallasi classification, change in cyst size after surgery, complicating subdural hygroma, symptom resolution, regrowth of the cyst, and reoperation (including additional CSF diversion).
Results
Twenty-eight MFACs in 28 patients were investigated. The average age at the time of surgery was 61.6 months. The average follow-up duration was 53.5 months. After surgery, 19 (90.5 %) of 21 patients with symptomatic MFACs experienced improvements. The cysts decreased in size in all cases (100 %, 28/28) and disappeared in three cases (11 %, 3/28). None of the cases experienced regrowth of the cyst. Subdural hygroma was identified in 23 cases (82.1 %) at the immediate postoperative period. Hygroma was asymptomatic in all cases but one. Hygroma disappeared in 19 cases (83 %) and decreased in size in three cases (13 %) in the long term. Only one case (4 %) required an additional subdural-peritoneal shunt. The rate of CSF diversion after the fenestration was significantly higher in patients with preoperative ventricular dilation (p = 0.0002).
Conclusion
Microsurgical fenestration for pediatric MFACs was considered to be safe and effective. Although subdural hygroma developed in significant number of patients at the immediate postoperative period, it was mostly asymptomatic and disappeared or decreased in size in the long term.
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References
Binitie O, Williams B, Case CP (1984) A suprasellar subarachnoid pouch; aetiological considerations. J Neurol Neurosurg Psychiatry 47:1066–1074
Helland CA, Wester K (2007) A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry 78:1129–1135
Hopf NJ, Perneczky A (1998) Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43:1330–1336, discussion 1336–1337
Di Rocco C (2010) Sylvian fissure arachnoid cysts: we do operate on them but should it be done? Childs Nerv Syst 26:173–175
Di Rocco C, Tamburrini G, Caldarelli M, Velardi F, Santini P (2003) Prolonged ICP monitoring in Sylvian arachnoid cysts. Surg Neurol 60:211–218
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 24:593–604
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 78:620–623
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
Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8:281–286
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
McBride LA, Winston KR, Freeman JE (2003) Cystoventricular shunting of intracranial arachnoid cysts. Pediatr Neurosurg 39:323–329
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
Gangemi M, Seneca V, Colella G, Cioffi V, Imperato A, Maiuri F (2011) Endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid cysts. J Neurosurg Pediatr 8:158–164
Germano 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 19:166–173
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
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
Di Rocco F, RJ S, Roujeau T, Puget S, Sainte-Rose C, Zerah M (2010) Limits of endoscopic treatment of sylvian arachnoid cysts in children. Childs Nerv Syst 26:155–162
Hamada H, Hayashi N, Umemura K, Kurosaki K, Endo S (2010) Middle cranial fossa arachnoid cyst presenting with subdural effusion and endoscopic detection of tear of the cyst—case report. Neurol Med Chir 50:512–514
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 26:163–172
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
Turhan T, Ersahin Y, Akinturk N, Mutluer S (2012) Fenestration methods for Sylvian arachnoid cysts—endoscopy or microsurgery. Childs Nerv Syst 28:229–235
El-Ghandour NM (2012) Endoscopic treatment of middle cranial fossa arachnoid cysts in children. J Neurosurg Pediatr 9:231–238
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
Fernandez Molina G (2013) Neuroendoscopic management of middle fossa arachnoid cysts. World Neurosurg 79:S19.e19–23
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
Di Rocco F, Yoshino M, Oi S (2005) Neuroendoscopic transventricular ventriculocystostomy in treatment for intracranial cysts. J Neurosurg 103:54–60
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
Oertel JM, Baldauf J, Schroeder HW, Gaab MR (2009) Endoscopic cystoventriculostomy for treatment of paraxial arachnoid cysts. J Neurosurg 110:792–799
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
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 19:159–165
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The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Okano, A., Ogiwara, H. The effectiveness of microsurgical fenestration for middle fossa arachnoid cysts in children. Childs Nerv Syst 32, 153–158 (2016). https://doi.org/10.1007/s00381-015-2908-y
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DOI: https://doi.org/10.1007/s00381-015-2908-y