Shunting for the Treatment of Arachnoid Cysts in Children

Alexiou, George Α.; Varela, Maria; Sfakianos, George; Prodromou, Neofytos

doi:10.1227/neu.0b013e3181f94476

Cited by 49 publications

(26 citation statements)

References 26 publications

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“…While there are various reports of this modality being safe and efficacious, there remain concerns over life-long shunt dependency (2,4,15). The incidence of shunt revision in these patients is approximately 30% (20).…”

Section: Resultsmentioning

confidence: 99%

Surgical management of intracranial arachnoid cysts: clinical and radiological outcome

Khan

Sonig

Thakur

et al. 2012

Turkish Neurosurgery

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AIm: Intracranial arachnoid cysts account for 1% of all intracranial mass lesions and may require drainage if symptomatic. mAterIAl and methOds:We retrospectively reviewed the medical records of 45 consecutive patients who underwent surgical drainage for symptomatic intracranial cysts at our institution from January 2000 to January 2010. The average age of our patients was 36.2 years; 26 were female and 19 were males. The most common symptoms included headaches (73.3%) and dizziness (35.6%).results: Cyst wall fenestration was carried out in 29 (64.4%), Cystoperitoneal shunting in 6 (13.3%) and endoscopic fenestration and stealth guided craniotomy in 5 patients each (11.1%). Seven patients had perioperative complications, and on discharge 79.1% of all patients had partial or complete clinical relief and 85.7% showed radiological decompression. A maximum cyst dimension of more than 5.0 cm was significantly associated with worse outcome at discharge (p=0.02). There was no association between post-operative size cyst decompression and resolution of clinical symptoms. The clinical and radiological outcomes were comparable between different surgical methods.COnClusIOn: There was no difference in the outcomes between different modalities. The extent of post-operative radiological reduction had no correlation with clinical outcomes, and should be assessed in relation to the patient's clinical status. BulGulAr: Kist duvarı fenestrasyonu 29 (%64,4) hastada, Kistoperitoneal şant (%13,3) hastada ve endoskopik fenestrasyon ve stealth kılavuzlu kraniyatomi her biri 5 hastada (%11,1) yapıldı. Yedi hastanın perioperatif komplikasyonları vardı ve taburcu olma sırasında hastaların %79,1'i kısmi veya tam klinik iyileşme yaşarken %85,7'si radyolojik dekompresyon gösteriyordu. Maksimum kist boyutunun 5,0 cm'den fazla olması taburcu olma zamanında daha kötü bir sonuçla anlamlı derecede ilişkiliydi (p=0,02). Postoperatif büyüklükle kist dekompresyonu ve klinik belirtileri geçmesi arasında ilişki yoktu. Klinik ve radyolojik sonuçlar farklı cerrahi yöntemler arasında benzerdi. sOnuÇ: Farklı modaliteler arasında sonuç farkı yoktu. Postoperatif radyolojik küçülme miktarının klinik sonuçlarla bir ilişkisi yoktu ve bunun hastanın klinik durumuna göre değerlendirilmesi gerekir.

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Section: Resultsmentioning

confidence: 99%

Surgical management of intracranial arachnoid cysts: clinical and radiological outcome

Khan

Sonig

Thakur

et al. 2012

Turkish Neurosurgery

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“…Our rates of surgical revision after endoscopic fenestration (3 of 7 [43%]) and CP shunting (5 of 10 [50%]) are similar to those of other single-center case series of patients with an arachnoid cyst. 2,5 Furthermore, although 6 (22%) patients had cyst growth (> 10 cm 3 ) compared with before the operation, 4 of 6 were aged ≤ 2 years at presentation, an age range in which most head growth occurs (thereby suggesting that the cyst may have enlarged proportionally with the child's growth). In addition, 2 of 6 patients (both of whom were aged ≤ 2 years at presentation) underwent reoperation, 1 related to CP shunt malfunction and the other related to closure of fenestration, which may also partially explain the postoperative cyst enlargement.…”

Section: Discussionmentioning

confidence: 99%

Exploring predictors of surgery and comparing operative treatment approaches for pediatric intracranial arachnoid cysts: a case series of 83 patients

Ali

Bennardo²,

Almenawer³

et al. 2015

PED

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OBJECT Although intracranial arachnoid cysts are a common incidental finding on pediatric brain imaging, only a subset of patients require surgery for them. For the minority who undergo surgery, the comparative effectiveness of various surgical approaches is debated. The authors explored predictors of surgery and compared operative techniques for pediatric patients with an intracranial arachnoid cyst seen at a tertiary care center. METHODS The authors reviewed records of pediatric patients with an intracranial arachnoid cyst. For each patient, data on baseline characteristics, the method of intervention, and surgical outcomes for the initial surgery were extracted, and cyst size at diagnosis was calculated (anteroposterior × craniocaudal × mediolateral). Baseline variables were analyzed as predictors of surgery by using logistic regression modeling, excluding patients whose surgery was not related to cyst size (i.e., those with obstructive hydrocephalus secondary to the cyst compressing a narrow CSF flow pathway or cyst rupture/hemorrhage). Data collected regarding surgical outcomes were analyzed descriptively. RESULTS Among 83 pediatric patients with an intracranial arachnoid cyst seen over a 25-year period (1989–2013), 27 (33%) underwent surgery; all had at least 1 cyst-attributed symptom/finding. In the multivariate model, age at presentation and cyst size at diagnosis were independent predictors of surgery. Cyst size had greater predictive value; specifically, the area under the curve for the receiver-operating-characteristic curve was 0.89 (95% CI 0.82–0.97), with an ideal cutoff point of ≥ 68 cm3. This cutoff point had 100% sensitivity (95% CI 79%–100%), 75% specificity (95% CI 61%–85%), a 53% positive predictive value (95% CI 36%–70%), and a 100% negative predictive value (95% CI 91%–100%); the positive likelihood ratio was 4.0 (95% CI 2.5–6.3), and the negative likelihood ratio was 0 (95% CI 0–0.3). Although the multivariate model excluded 7 patients who underwent surgery (based on prespecified criteria), excluding these 7 cases did not change the overall findings, as shown in a sensitivity analysis that included all the cases. Descriptive results regarding surgical outcomes did not indicate any salient differences among the surgical techniques (endoscopic fenestration, cystoperitoneal shunting, or craniotomy-based procedures) in terms of symptom resolution within 6 months, need for reoperation to date, cyst-size change from before the operation, morbidity, or mortality. CONCLUSIONS The results of these exploratory analyses suggest that pediatric patients with an intracranial arachnoid cyst are more likely to undergo surgery if the cyst is large, compresses a narrow CSF flow pathway to cause hydrocephalus, or has ruptured/hemorrhaged. There were no salient differences among the 3 surgical techniques for several clinically important outcomes. A prospective multicenter study is required to enable more robust analyses, which could ultimately provide a decision-making framework for surgical indications and clarify any differences in the comparative effectiveness of surgical approaches to treating pediatric intracranial arachnoid cysts.

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“…In this report we reviewed arachnoid cysts with a focus on the surgical management and selection criteria for management. All authors agree that symptoms of intracranial hypertension (with or without hydrocephalus), intractable seizures, and focal neurological deficits warrant treatment (1,4,6,7,12). Our selection criteria for management were age, symptomatic presentation, lesion location, and close communication with a ventricle or a cisternal compartment.…”

Section: Discussionmentioning

confidence: 97%

“…With the advent of modern treatment techniques, debate continues regarding which surgical treatment is most effective (1)(2)(3)5,9,10,11). Treatment options of arachnoid cysts include expectant management, cyst shunting, craniotomy for fenestrations, deviation of cyst fluid to another intracranial space, stereotactic aspiration and endoscopic fenestration.…”

Section: Introductionmentioning

confidence: 99%

Surgical management strategies of intracranial arachnoid cysts: a single institution experience at 75 cases

Düz

Kaya²,

Daneyemez³

et al. 2012

Turkish Neurosurgery

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AIm: Arachnoid cysts are benign intra-arachnoid cystic lesions filled with cerebrospinal fluid. With advent of modern treatment techniques, debate continues regarding which surgical treatment is most effective. mATeRIAL and meTHods: A consecutive series of 75 patients with arachnoid cysts that were surgically treated between January 1992 and December 2009 are reported. Included in the study were 54 male and 21 female patients, ranging in age from 2 months to 45 years (mean age 20.02 years) at the time of surgery. Symptoms at presentation, location on the cysts, and treatment modalities were evaluated.ResuLTs: Headache was controlled in 92.5% of adult cases. Hydrocephalus, cognitive decline weakness and gait disturbances were controlled 100% after overall treatment methods. Follow-up CT scans showed significant reduction in cyst size in supratentorial arachnoid cysts. No significant changes in cyst size were found in infratentorial cysts but symptomatic improvements were noted. CoNCLusIoN:Patients with symptomatic arachnoid cysts regardless of age and cyst location should be treated. We think that avoiding shunt dependence should be one of the principle treatment goals. Proper patient selection results in good outcomes. BuLGuLAR: Erişkin olguların %92,5'inde baş ağrısı kontrol altına alındı. Tüm tedavi şekilleri sonrasında hidrosefali, bilişsel bozulmalar ve yürüyüş bozuklukları %100 kontrol altına alındı. Takip tomografi görüntüleri supratentorial kistlerin boyutunda belirgin azalma gösterdi. İnfratentorial kistlerde belirgin küçülme saptanmasa da klinik olarak belirgin düzelme kaydedildi. soNuÇ: Semptomatik araknoid kisti olan olgular yaşına ve kist yerleşimine bakılmaksızın tedavi edilmelidirler. Şant bağımlılığını önlemek tedavinin prensiplerinden birisi olmalıdır. Doğru hasta seçimi tedavi yöntemlerinin başarısını artırmaktadır.

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Shunting for the Treatment of Arachnoid Cysts in Children

Abstract: Shunt placement is a safe and effective surgical treatment of symptomatic arachnoid cysts in children. Cyst reduction is greater in children younger than 2 years of age.

Cited by 49 publications

References 26 publications

Surgical management of intracranial arachnoid cysts: clinical and radiological outcome

Surgical management of intracranial arachnoid cysts: clinical and radiological outcome

Exploring predictors of surgery and comparing operative treatment approaches for pediatric intracranial arachnoid cysts: a case series of 83 patients

Surgical management strategies of intracranial arachnoid cysts: a single institution experience at 75 cases

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