Microsurgical fenestration and cystoperitoneal shunt through preauricular subtemporal keyhole craniotomy for the treatment of symptomatic middle fossa arachnoid cysts in children

Sılav, Gökalp; Sarı, Ramazan; Bölükbaşı, Fatih Han; Altaş, Murat; Işık, Nihal; Elmacı, İlhan

doi:10.1007/s00381-014-2530-4

Cited by 26 publications

(12 citation statements)

References 31 publications

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“…The patient is placed in the lateral park bench position. The patient's head is rotated about 10°-20°to the contralateral side from the lateral position to provide a direct view angle with less retraction to the cerebellar hemisphere and can open the [35,37,60] Middle fossa arachnoid cysts Level III [39,66] cerebellopontine angle cistern successfully. During the operation, based on the location of the lesion, the view angle can be adjusted by changing the degree of inclination (left and right) of the operating bed.…”

Section: Head Positionmentioning

confidence: 99%

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

Lan

Sughrue

Hopf³

et al. 2019

Neurosurg Rev

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Meeting of experts and drafting the statement Members of the expert panel met in Suzhou, China, November 5, 2018, as a subcommittee meeting at the 2018 Education Course of the ISMIN. The meeting utilized the outlines created from the literature review as a draft for structuring the discussion. Opinions of the experts were transcribed and discussed in detail to ensure that the statement best reflects the experts' view. Findings of the committee based on literature and expert opinions Commonly applied keyhole microsurgery approaches Supraorbital keyhole approach Indication (Table 1

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Section: Head Positionmentioning

confidence: 99%

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

Lan

Sughrue

Hopf³

et al. 2019

Neurosurg Rev

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“…There is a great debate about the best surgical options for asymptomatic patients with intracranial ACs [18, 20, 29, 30] with reported advantages and disadvantages for each surgical technique [8]. In our study, the first line of treatment for these ACs was microsurgical fenestration.…”

Section: Discussionmentioning

confidence: 88%

Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

et al. 2021

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Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). Discussion/Conclusion: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.

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“…With regard to large ACs, there has been no consensus on the single best management strategy. For symptomatic cases, many different surgical procedures have been proposed, including cyst excision or cyst fenestration using microscopy or endoscopy and/or shunt placement [19-23]. This case is more difficult to manage because of the remarkable degrees of brain shift and OM [24].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Giant Arachnoid Cyst Associated with an Orbital Meningocele: A Case Report and Cystoperitoneal Shunt Management

et al. 2021

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Introduction: Intracranial arachnoid cysts (ACs) are space-occupying lesions that typically remain stable in size and clinically silent over time. Case Report: We describe an unusual pediatric case of enlarged AC impressive by its compressive phenomena. An 11-month-old girl presented with remarkable macrocephaly associated with a cystic orbital tumor. CT scan and MRI studies revealed a large intracranial ACs extending in the orbit with an orbital meningocele (OM). The intracranial cyst did communicate with the orbital one into a bony defect in the right inner region of the orbital roof and represses the globe outward. A cystoperitoneal shunting procedure was performed to remove the mass effect as soon as possible and facilitate normal development. Discussion/Conclusion: Cysts in infants younger than 1 year of age are remarkably different from those in older children and adults in terms of cyst localization and enlargement. Classically described complications result from compression of adjacent structures and include focal neurologic involvement, headaches and seizures and developmental deficits, or macrocephaly in younger children. There are few cases of ACs with ophthalmic manifestations reported in the literature. The paucity of literature prompted us to analyze the case. To the best of our knowledge, an AC accompanying OM has not been reported. The pathogenesis and management of the case will be discussed.

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Microsurgical fenestration and cystoperitoneal shunt through preauricular subtemporal keyhole craniotomy for the treatment of symptomatic middle fossa arachnoid cysts in children

Abstract: Microsurgical fenestration with keyhole craniotomy to provide passage between cysts to basal cisterns together with cystoperitoneal shunting during the same operation is still an effective and safe method in cases with symptomatic middle fossa arachnoid cysts in children.

Cited by 26 publications

References 31 publications

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

Giant Arachnoid Cyst Associated with an Orbital Meningocele: A Case Report and Cystoperitoneal Shunt Management

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