Congenital Arachnoid Cysts in Children

Balsubramaniam, Chidambaram; Laurent, John P.; Rouah, Emilie; Armstrong, Dawna L.; Feldstein, Neil A.; Schneider, Steven J.; Cheek, William R.

doi:10.1159/000120473

Cited by 20 publications

(11 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We attribute much o f our recent success in group 2 patients to more aggressive, open fenestration procedures where multiple openings in the cyst wall are best achieved, while at the same time making our cranioto mies progressively smaller. The overall 14% complication rate and the 0% mortali ty rate in our series (table 5) compare favorably to other pediatric series reported in the literature [7,15,22]. The rate o f postoperative complications declined from group 1 (16%) to group 2 (13%).…”

Section: Discussionsupporting

confidence: 83%

“…There continues to be a lack o f consensus as to which method provides the optimal management o f these le sions for particular patients. Numerous reports have claimed good results primarily with fenestration [6][7][8][9][10][11][12][13][14], while others recommend C P shunting [15][16][17][18][19][20]. Although the European cooperative study performed by Oberbauer et al [21] reported that craniotomy with fenestration was the most common surgical approach, the debate continues regarding the best surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Treatment of 95 Children with 102 Intracranial Arachnoid Cysts

Fewel

Levy

McComb³

1996

Pediatr Neurosurg

113

View full text Add to dashboard Cite

Our review of 95 children with 102 intracranial arachnoid cysts treated surgically from 1976 to 1996 is presented. These patients are divided into two groups, those initially treated from 1976 to 1986 and those treated from 1987 to May 1996, to see whether any improvement in outcome had occurred. There were 31 patients (20 males/11 females) with 34 cysts treated from 1976 to 1986 and 64 patients (45 males/19 females) with 68 cysts treated from 1987 to 1996. The mean age at presentation for all cases was 4.9 years (range from 3 days to 17.8 years). The most common cyst location was the middle fossa. Treatment options for the management of intracranial arachnoid cysts include fenestration or shunting. We consider the avoidance of a shunt as a primary goal in the management of these patients. Accordingly, 82 (80%) of the cysts in our series were treated initially by fenestration. Fifty percent of those initially fenestrated from 1976 to 1986 required no further treatment as compared with 60% fenestrated from 1987 to 1996. The success rate of fenestration among those patients without associated hydrocephalus was significantly higher than in those with hydrocephalus; 73% without hydrocephalus required no additional treatment versus 32% with hydrocephalus. Seventeen percent of the patients treated from 1976 to 1986 required a subsequent ven-triculoperitoneal shunt as compared with 22% treated from 1987 to 1996. Twenty-nine percent of those patients initially fenestrated from 1976 to 1986 required a subsequent cystoperitoneal shunt as compared with only 12% treated from 1987 to 1996. Although not statistically significant, the second group of patients had a lower rate of reoperation, fewer complications, and a better clinical outcome than the first group. We recommend that in patients without evidence of hydrocephalus, cyst fenestration be considered as the primary procedure, as 73% of the patients in the two series remain shunt free. In those patients with hydrocephalus, we still recommend cyst fenestration, but with a ventriculoperitoneal shunt inserted before fenestration if the hydrocephalus is marked or after fenestration if the hydrocephalus is progressive.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of 95 Children with 102 Intracranial Arachnoid Cysts

Fewel

Levy

McComb³

1996

Pediatr Neurosurg

113

View full text Add to dashboard Cite

show abstract

“…True arachnoid cysts are congenital lesions [22] that are thought to arise from abnormal splitting or duplication of the arachnoid membrane during development [23,24,25,26]. Secondary arachnoid cysts, on the other hand, may result from trauma [27, 28], infection or hemorrhage in the subarachnoid space [29].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Fenestration of Middle Fossa Arachnoid Cysts: A Technical Description and Case Series

Elhammady

Bhatia

Ragheb³

2007

Pediatr Neurosurg

View full text Add to dashboard Cite

Background: Arachnoid cysts are intra-arachnoidal cerebrospinal fluid collections most frequently seen in the middle cranial fossa. The optimal method of treatment for symptomatic arachnoid cysts remains controversial and includes cyst shunting, open craniotomy and endoscopic fenestration. All these techniques, however, have been associated with the development of postoperative subdural fluid collections. We describe a new endoscopic transcortical technique that attempts to avoid this complication. Methods: Six patients with middle cranial fossa arachnoid cysts were treated with endoscopic fenestration at our institution between January 2002 and December 2005. Three cases were approached directly through the cyst, while the other 3 were approached by passing the endoscope through the rim of adjacent cortex. Results: All six endoscopic fenestrations were successful in treating the arachnoid cysts. Among the 3 patients treated via a direct cyst entry, 2 cases developed significant subdural hygromas, 1 of which required aspiration. On the other hand, 1 of the 3 cases treated using a transcortical technique developed an insignificant postoperative extra-axial collection that resolved at 3 months without intervention. Conclusion: Endoscopic fenestration is an effective treatment for symptomatic arachnoid cysts. Endoscopic fenestration via a transcortical approach attempts to minimize cerebrospinal fluid drainage into the subdural space, avoiding the development of significant postoperative extra-axial collections, while promoting flow into the basal cisterns.

show abstract

“…Many institutions, such as ours, have favored initial cyst fenestration, usually into the basal cisterns. 4,7,8,11,13,14,16,21,23,25,28 Other centers have advocated the placement of CP shunts as a primary treatment for these cysts. 3,27 The clinical presentation of patients with arachnoid cysts, especially during the first few years of life, may offer considerable insight into the relationship between these lesions and underlying aberrancies in CSF flow.…”

mentioning

confidence: 99%

Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Zada

Krieger²,

McNatt³

et al. 2007

FOC

View full text Add to dashboard Cite

Object Arachnoid cysts can cause a variety of clinical signs and symptoms in infants. The authors sought to determine whether the clinical presentation of pediatric patients younger than 2 years old and harboring arachnoid cysts influenced the type of intervention that would be required. Methods A retrospective chart review was conducted for all patients younger than 2 years of age who had undergone craniotomy for fenestration of an arachnoid cyst at the Childrens Hospital Los Angeles between 1995 and 2006. Forty-two patients were included in the study. The mean age was 10.4 months. The median follow-up time was 33 months. Clinical presentations were as follows: macrocephaly without ventriculomegaly (21 patients, 50%), hydrocephalus (six patients, 14%), and other symptoms (15 patients, 36%). After fenestration of the arachnoid cyst, 12 of 21 patients (57%) presenting with nonspecific macrocephaly required placement of a cystoperitoneal or ventriculoperitoneal shunt, compared with 1 of 15 patients (7%) presenting with other symptoms (p value = 0.0039). Five of six patients with hydrocephalus (83%) were shunt dependent following fenestration. Overall, 18 of 42 patients (43%) were shunt dependent after fenestration. Ten of these patients (55%) required revisions during the follow-up period. Conclusions Patients younger than 2 years of age and harboring an arachnoid cyst commonly present with macrocephaly. These patients are more likely to require shunts than are those presenting with other findings, such as seizu

show abstract

Congenital Arachnoid Cysts in Children

Cited by 20 publications

References 39 publications

Surgical Treatment of 95 Children with 102 Intracranial Arachnoid Cysts

Surgical Treatment of 95 Children with 102 Intracranial Arachnoid Cysts

Endoscopic Fenestration of Middle Fossa Arachnoid Cysts: A Technical Description and Case Series

Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Contact Info

Product

Resources

About