Open Surgical Excision of Intracranial Arachnoid Cysts after Initial Procedure Failure in Children

Abstract

Background: Intracranial arachnoid cysts (IAC) are pathological conditions that occur in 2.6% of children. Different surgical procedures had significant failure rate. The objective of the current study is to evaluate the effectiveness of open surgical excision in failed first-other surgery. Patients and methods: A total of 23 patients with symptomatic arachnoid cysts, with radiological evidence who had had one previous failed surgical intervention, shunting or endoscopic fenestration, underwent open surgical excision of the arachnoid cyst at the Neurosurgery Department of Benha University and Benha Children Hospitals through the period from January 2018 to January 2022. Results: Children with IAC underwent open surgical excision, totalling 9 (39.1%) cases and partial in 14 (60.9%) cases. In 13 cases, associated microscopic fenestration to basal arachnoid cisterns was done. The mean follow-up period is 28.36 (SD 3.97) months with 77.3% success and 22.7% failure with subsequent treatment by cystoperitoneal shunting. Total excision success is 100%, but partial excision is 64.3%, with 88.9% of them being associated with microscopic fenestration. Mild early transient complications were reported in only 3 cases and were conservatively treated, but late complications occurred in 2 cases. Conclusion: Open surgical excision of IAC has a very good success rate in the treatment of intracranial arachnoid cysts after initial procedure failure; complete excision should be the main aim whenever possible for optimum results that force us to ask: "Could it be the first line of surgical treatment in symptomatic untreated cases?"