Long-term results of cystoperitoneal shunt placement for the treatment of arachnoid cysts in children

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors present a single-institution experience in shunt treatment for arachnoid cysts (ACs).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between January 2003 and January 2005, 62 patients with ACs underwent cystoperitoneal (CP) shunt placement at the authors' institution. All patients were evaluated with CT or MRI studies and had regular follow-up examinations.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-six cysts (74%) were within the sylvian fissure, 8 (13%) were in the cerebral convexity, and 8 (13%) were infratentorial. A CP shunt was placed in all patients. Follow-up imaging studies showed that 59 (95%) of 62 ACs reduced in size during a mean postoperative follow-up period of 6.5 years (range 6–8 years). Although a CP shunt was effective in achieving early obliteration, shunt dependency occurred within the patient group (13%). Shunt revision for various reasons was performed in 16 patients (26%).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Shunt placement is a safe and effective surgical treatment for symptomatic ACs in children, although efforts should be made to decrease complications in the procedure.</jats:p></jats:sec>

Surgery for intracranial arachnoid cysts in children—a prospective long-term study

“…The causative relationship between ACs and epileptic seizures is controversial [22]. Similar to our results, some studies find a complete resolution of seizures in some patients, while other patients experience either a reduced or an unchanged frequency of seizures [23].…”

Surgical treatment of intracranial arachnoid cyst in adult patients

“…[11] If cystoperitoneal shunt is necessary for alleviating the symptoms or avoiding complications caused by the fierce variation of intracranial pressure, the use of a cystoperitoneal shunt with an adjustable valve is highly recommended. [12,13] Advancing technology provides us a new choice of treatment for IAC. However, no gold standard criteria exist for different individuals.…”

Management of subdural hygromas associated with arachnoid cysts

“…3,9,28 These pressure elevations sometimes persist for long durations postoperatively, occasionally resulting in permanent shunt placement, even if that was not the original surgical plan. 3,84,85 The new onset of subdural hygroma is a recognized side effect of arachnoid cyst fenestration. In reported series, surgical fenestration of arachnoid cysts has resulted in iatrogenic postoperative subdural hygroma in approximately 4% to 29% of cases.…”

“…40,49,69 We believe that subdural shunt placement, a treatment that has been sometimes advocated for these lesions, 3,28 will usually result in the unintended effect of maintaining a fistula though this torn lining, thus leading to a persistent tear and shunt dependency. 33,85 Acetazolamide has occasionally been used to treat symptomatic hygromas associated with arachnoid cysts. Of the reported cases in which this treatment was tried, 2 patients had symptom resolution without surgery 11,45 and 1 patient went on to have surgical decompression of the hygroma.…”

“…7,18,21,25,27,28,37,44,46,48,50,55,85 In some cases, previously asymptomatic arachnoid cysts may rupture, causing a symptomatic hygroma in the subdural space. 3,6,9,11,12,15,18,23,26,28,42,58,62,68,82 Most prior reports have advocated surgical treatment for arachnoid cyst-associated subdural hygromas.…”