Postoperative Complications of Microscopic Fenestration for Middle Fossa Arachnoid Cysts: A Retrospective Study of 38 Cases and Literature Review

Abstract

Introduction: Middle fossa arachnoid cyst (MFAC) is one of the most common cranial cysts in children, and the various postoperative complications following cyst fenestration represent a major concern. We conducted a retrospective study in our department and performed a systematic review of the literature to identify the risk factors for complications. Methods: A retrospective survey was conducted on 38 patients with MFAC (< 14 years) who underwent microscopic fenestration from January 2019 to December 2020. Postoperative complications, including postoperative hemorrhage/hematoma, subdural hygroma (SH), cranial nerve palsy, central nervous system infection (PCNSI), and cerebrospinal fluid (CSF) leak, were collected. A systematic PubMed search for cohort studies on surgically treated MFAC published after 1980 was performed. The postoperative complications in the included studies were illustrated. Results: The overall complication rate in our series was 7.9%, among whom, nine patients (23.7%) developed postoperative SH, one of which required cyst-peritoneal shunting. Patients who developed SH were significantly younger (4.0 ± 1.8 vs 6.3 ± 3.4 years, p = 0.012). Binary logistic analysis showed that a lower age could be a risk factor for developing SH (odds ratio: 0.738, p = 0.067). One patient developed a subdural hematoma. No cranial nerve palsy or CSF leak was observed. Eighteen studies were included in the systematic review, comprising 649 cases of MFAC. The most common complication was SH (4.9%), and the postoperative complication rates were similar between the microscopic and endoscopic techniques. Conclusion: The complication rate of MFAC fenestration is considerable. SH is the most common postoperative complication, and it mostly occurs in young children. Strict surgical indications should be applied for young children.

Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults

“…In the multivariate analysis, only postoperative hydrocephalus was significant ( p = 0.02). Complications and frequencies after both microscopic/endoscopic and stereotactic procedures in the adult group of our cohort were comparable to other studies [ 2 , 8 , 18 , 21 ]. In the pediatric cohort, we have to emphasize a high risk of intraoperative bleeding due to altered anatomical structures, which was also described earlier [ 25 ].…”

“…In the pediatric cohort, we have to emphasize a high risk of intraoperative bleeding due to altered anatomical structures, which was also described earlier [ 25 ]. One study [ 18 ] defined a postoperative subdural hematoma as a possible risk factor favoring revision surgery; however, we were the first to describe postoperative hydrocephalus as a significant finding for re-surgery.…”

Nontraumatic symptomatic de novo arachnoid cyst in an adolescent patient treated with cystoperitoneal shunting: illustrative case

“… 8 Various treatment methods for symptomatic arachnoid cysts have been described, including craniotomy for cyst drainage and/or resection, 6 , 8 , 9 as well as microsurgical or endoscopic cyst fenestration. 3 , 18 , 19 Previous prospective studies have found that surgery for arachnoid cyst treatment is relatively safe and can yield significant clinical benefit in both children and adults. 1 , 20 Cystoperitoneal shunting is another surgical option for these patients and has been described in prior cases of symptomatic arachnoid cysts.…”

“… 22 Additionally, complications associated with cyst fenestration such as subdural hygroma and cyst recurrence are avoided with shunt placement. 19 , 22 However, permanent shunts and accompanying craniotomies have their own set of potential complications and risks, such as shunt revision and infection, and should also be taken into account during treatment selection.…”