Shunting procedures in the management of intracranial cerebrospinal fluid cysts in infancy and childhood

Serlo, Willy; Wendt, Lennart von; Heikkinen, E; Saukkonen, Anna‐Liisa; Nyström, S. H. M.

doi:10.1007/bf01418470

Cited by 26 publications

(9 citation statements)

References 13 publications

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“…The "endoscopic" group (including our cases) was treated by fenestration through a suboccipital supracerebellar approach (2 cases) [3], lateral ventricle cystostomy (9 cases) [5,6] and third ventricle−cystostomy (5 cases) [4,6,7]. The "surgical" group was treated by craniotomy and cyst fenestration or excision (6 cases) [10,17,19 ± 21] ventricular shunt (5 cases) [11,14,18], shunt of the cyst (one case) [16], shunt of both cyst and ventricles (4 cases) [11,15,16], craniotomy and cyst fenestration with shunt of ventri− cular system (2 cases) [12,13] or of both cyst and ventricles (2 cases) [14,16].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Quadrigeminal Cistern Arachnoid Cysts

Gangemi

Maiuri

Colella

et al. 2005

Minim Invasive Neurosurg

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Five patients with arachnoid cysts of the quadrigeminal cistern treated by endoscopic fenestration are reported and another eleven well-documented cases from the literature are reviewed. Among the five personal cases four were children and one was adult; the cyst fenestration was performed from the lateral ventricle in three cases and from the third ventricle in two. In four patients the endoscopic treatment resulted in clinical remission, whereas a two-month-old baby later required a shunt. The lateral ventricle-cystostomy and the third ventricle-cystostomy (according to the cyst extent) are the best endoscopic procedures, whereas the cyst fenestration through a suboccipital supracerebellar approach is no longer used. The rate of cured or improved patients after endoscopic surgery (14/16 or 87.5%) was rather similar to that of a group of twenty patients treated by traditional surgery (craniotomy and cyst excision and/or shunt) (85%). These data confirm that endoscopic fenestration of quadrigeminal cistern cysts must be performed as the first procedure because it is less invasive and avoids shunt dependency.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Quadrigeminal Cistern Arachnoid Cysts

Gangemi

Maiuri

Colella

et al. 2005

Minim Invasive Neurosurg

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“…The most common procedures are shunt placements and fenestrations of the cysts, but both procedures have drawbacks2,11,14). The shunt operation is a non-invasive, simple, and safe procedure compared to direct removal of cyst walls43). According to Punzo et al38), shunt operations must be considered in the following cases : 1) when the non-communicative arachnoid cysts are accompanied by hydrocephalus and the basal cisterns are obstructed; 2) when neither mass effect nor hydrocephalus was confirmed on radiography; and 3) when long surgical times enhance the risks.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Neuroimaging Outcomes of Surgically Treated Intracranial Cysts in 110 Children

Lee

2012

J Korean Neurosurg Soc

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ObjectiveThe indications and optimal surgical treatments for intracranial cysts are controversial. In the present study, we describe long-term clinical and neuroimaging results of surgically treated intracranial cysts in children. The goal of this study is to contribute to the discussion of the debate.MethodsThis study included 110 pediatric patients that underwent surgeries to treat intracranial cysts. Endoscopic cyst fenestrations were performed in 71 cases, while craniotomies and cyst excisions (with or without fenestrations) were performed in 30 patients. Cystoperitoneal shunts were necessary for nine patients. Long-term results were retrospectively assessed with medical and neuroimaging records.ResultsClinical and radiological improvement was reported in 87.3% and 92.8% of cases, respectively, after endoscopic neurosurgery, and in 93.3% and 100% using open microsurgery whereas 88.9% and 85.7% after shunt operation. There were no statistical differences in clinical outcomes (p=0.710) or volume reductions (p=0.177) among the different surgeries. There were no mortalities or permanent morbidities, but complications such as shunt malfunctions, infections, and subdural hematomas were observed in 56% of the patients that had shunt operations. A total of 13 patients (11.8%) underwent additional surgeries due to recurrences or treatment failures. The type of surgery performed did not influence the recurrence rate (p=0.662) or the failure rate (p=0.247).ConclusionEndoscopic neurosurgeries are less invasive than microsurgeries and are at least as effective as open surgeries. Thus, given the advantages and complications of these surgical techniques, we suggest that endoscopic fenestration should be the first treatment attempted in children with intracranial cysts.

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“…2,4,40 Performing a craniotomy allows the surgeon to inspect the cyst wall, 2,26,41 coagulate any arachnoidal blood vessels, 24 and confirm the diagnosis with tissue biopsy. 4,35,39,[43][44][45] Endoscopic cystocisternostomy is also reported in the literature. Only sporadic reports of clinical recurrence after fenestration can be found in the literature.…”

Section: Discussionmentioning

confidence: 94%

“…1,2,[4][5][6]10,26,35,36 Cyst fenestration, stereotactic puncture, endoscopic cyst fenestration, cystoperitoneal shunt, cyst marsupialization into the subarachnoid space, and complete or partial resection of the cyst wall are the main options. 2,4,35,39,40 Most authors prefer craniotomy and fenestration or marsupialization of the cyst wall. 2,4,35,39,40 Most authors prefer craniotomy and fenestration or marsupialization of the cyst wall.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Arachnoid Cysts

Erman¹,

Göçer²,

Tuna³

et al. 2004

Neurosurgery Quarterly

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The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cysts (ACs) in our clinic. The study was carried out between Turkey. Thirty-five patients (13 female and 22 male) with ACs demonstrated by cranial magnetic resonance imaging or computed tomography during this period were enrolled and discussed in this study. The middle cranial fossa was the most common location of ACs; ACs were located in the middle cranial fossa in 22 (62.9%) cases, followed by the cerebellopontine angle in 4 (11.4%) cases, the cerebral convexity in 3 (8.6%) cases, the suprasellar region in 2 (5.7%) cases, the quadrigeminal cisterns in 2 (5.7%) cases, and the retrocerebellar region in 2 (5.7%) cases. All cysts were unilateral: 25 (71.4%) were located on the left side, and 10 (28.6%) were located on the right side. The mean age at onset of clinical manifestations was 3 years, 6 months (range: 1 month to 12 years). The mean age at diagnosis was 8 years (range: 1-32 years). The most frequent clinical features on presentation were epileptic seizures (42.9%) and headache (28.6%). A few patients (9 [25.7%]) underwent surgery. Surgical intervention with microsurgical excision and fenestration was performed in 7 patients, and cystoperitoneal shunting was performed in 2 patients. The major indications for surgery of ACs are intractable seizures, intracranial hypertension, and compression of neuronal tissues. Headache only is not a surgical indication. Microsurgical excision and fenestration are safe and effective for the surgical treatment of ACs. RESULTSDuring the study period, 35 patients were investigated. Of these patients, 13 (37.1%) were female and 22 (62.9%)

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Shunting procedures in the management of intracranial cerebrospinal fluid cysts in infancy and childhood

Cited by 26 publications

References 13 publications

Endoscopic Treatment of Quadrigeminal Cistern Arachnoid Cysts

Endoscopic Treatment of Quadrigeminal Cistern Arachnoid Cysts

Clinical and Neuroimaging Outcomes of Surgically Treated Intracranial Cysts in 110 Children

Intracranial Arachnoid Cysts

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