Abstract
Objective
The objective of this study is to establish which treatment is the best operative intervention for arachnoid cyst.
Materials and methods
We reviewed a series of 209 cases with arachnoid cysts focusing on the effectiveness and safety. The cysts were treated with several surgical procedures including open surgery for fenestration, endoscopic fenestration, or cystoperitoneal shunting.
Results
Follow-up imaging studies showed that 176 out of 209 arachnoid cysts (84.2%) reduced in size during a mean postoperative follow-up period of 6.9 years (range, 1 to 14 years). Although a cystoperitoneal shunt was the best method for early achieving an obliteration of the sylvian cyst (89%), it had the danger of shunt dependency (42%) in addition to four early complications. Although endoscopic fenestration tended to be less effective in reducing the size of a sylvian cyst, it was safe and particularly effective in completely obliterating a suprasellar, quadrigeminal, and prepontine cyst.
Conclusion
Although the shunt for arachnoid cyst can get the more rapid good radiological outcome, the shunt-related complication and dependency would be hazardous. We suggest that endoscopic or reduced open procedures offer the advantage of avoiding a large craniotomy or the known complications of a cystoperitoneal shunt in treatment of arachnoid cysts. We could get the nearly same surgical outcome without shunt complications with endoscopic or open procedures.
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References
Aoki N, Sakai T (1990) Intraoperative subdural hematoma in a patient with arachnoid cyst in the middle cranial fossa. Childs Nerv Syst 6:44–46
Aoki N, Sakai T, Umezawa Y (1990) Slit ventricle syndrome after cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst. Childs Nerv Syst 6:41–43
Caemaert J, Abdullah J, Calliauw L, Carton D, Dhooge C, van Coster R (1992) Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 119:68–73
Charalampaki P, Filippi R, Welschehold S, Conrad J (2005) Endoscopic and endoscope-assisted neurosurgical treatment of suprasellar arachnoidal cysts (Mickey Mouse cysts). Minim Invasive Neurosurg 48:283–288
Choi JU, Kim DS, Huh R (1999) Endoscopic approach to arachnoid cyst. Childs Nerv Syst 15:285–291
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
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
Dei-Anang K, Voth D (1989) Cerebral arachnoid cyst: a lesion of the child’s brain. Neurosurg Rev 12:59–62
Ersahin Y, Kesikci H, Ruksen M, Aydin C, Mutluer S (2008) Endoscopic treatment of suprasellar arachnoid cysts. Childs Nerv Syst 24:1013–1020
Galassi E, Piazza G, Gaist G, Frank F (1980) Arachnoid cysts of the middle cranial fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 14:211–219
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 (Wien) 42:201–204
Gangemi M, Colella G, Magro F, Maiuri F (2007) Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 21:276–280
Geissinger JD, Kohler WC, Robinson BW, Davis FM (1978) Arachnoid cysts of the middle cranial fossa: surgical considerations. Surg Neurol 10:27–33
Hagebeuk EE, Kloet A, Grotenhuis JA, Peeters EA (2005) Bobble-head doll syndrome successfully treated with an endoscopic ventriculocystocisternostomy. Case report and review of the literature. J Neurosurg 103:253–259
Hanieh A, Simpson DA, North JB (1988) Arachnoid cysts: a critical review of 41 cases. Childs Nerv Syst 4:92–96
Harsh GR IV, Edwards MS, Wilson CB (1986) Intracranial arachnoid cysts in children. J Neurosurg 64:835–842
Kim DS, Choi JU, Huh R, Yun PH, Kim DI (1999) Quantitative assessment of cerebrospinal fluid hydrodynamics using a phase-contrast cine MR image in hydrocephalus. Childs Nerv Syst 15:461–467
LaCour F, Trevor R, Carey M (1978) Arachnoid cyst and associated subdural hematoma. Observations on conventional roentgenographic and computerized tomographic diagnosis. Arch Neurol 35:84–89
Okumura Y, Sakaki T, Hirabayashi H (1995) Middle cranial fossa arachnoid cyst developing in infancy. Case report. J Neurosurg 82:1075–1077
Pei A, Zhang YZ, Zong XY, Wang XS, Song M (2007) Endoscopic treatment of suprasellar arachnoid cysts. Zhonghua Yi Xue Za Zhi 87:311–314
Rappaport ZH (1993) Suprasellar arachnoid cysts: options in operative management. Acta Neurochir (Wien) 122:71–75
Santamarta D, Aguas J, Ferrer E (1995) The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 38:133–137
Schroeder HW, Gaab MR (1997) Endoscopic observation of a slit-valve mechanism in a suprasellar prepontine arachnoid cyst: case report. Neurosurgery 40:198–200
Schroeder HW, Gaab MR, Niendorf WR (1996) Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85:293–298
Sprung C, Mauersberger W (1979) Value of computed tomography for the diagnosis of arachnoid cysts and assessment of surgical treatment. Acta Neurochir Suppl (Wien) 28:619–626
Stein SC (1981) Intracranial developmental cysts in children: treatment by cystoperitoneal shunting. Neurosurgery 8:647–650
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
Wang JC, Heier L, Souweidane MM (2004) Advances in the endoscopic management of suprasellar arachnoid cysts in children. J Neurosurg 100:418–426
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Shim, KW., Lee, YH., Park, EK. et al. Treatment option for arachnoid cysts. Childs Nerv Syst 25, 1459–1466 (2009). https://doi.org/10.1007/s00381-009-0930-7
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DOI: https://doi.org/10.1007/s00381-009-0930-7