Supraorbital keyhole microsurgical fenestration of symptomatic temporal arachnoid cysts in children, advantages and limitations.

Abstract

Preoperative clinical presentation of the patients included headache (80%), nausea & vomiting (64%), drug resistant epilepsy (52%), macrocephaly (12%) papilledema (28%), motor weakness in the form of right-sided hemiparesis (12%) and cranial nerve palsy. Postoperative complete subsidence of headache was noted in 50%, while 20% remained unchanged. Drug resistant epilepsy improved in 69% of the patients. Postoperative MRI showed initial decrease in cyst volume as early as 3 months, only in a range of 5-12% volume reduction, and the late follow-up done at 6 and 18 months continued to show further reduction reported to be significant (p < 0.001). Transient subgaleal cerebrospinal fluid (CSF) collection was the most common complication (20%). Only 1 patient experienced CSF leak mandating cysto-peritoneal shunting. Conclusıon: Eyebrow supraorbital keyhole microsurgical fenestration for temporal arachnoid cysts can be performed with a fairly low risk of complications and yields a favorable improvement in clinical and neuroimaging outcomes.

Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes

“…18,53 In this systematic review, only three cases of CSF rhinorrhea were reported in the pediatric literature out of all studies (2%). 7,44,50 Lastly, development of a pseudomeningocele can be of concern for cosmetic and wound healing reasons. General prevalence postoperatively has been reported to be 0.07% to 2% in adult patients.…”

“…Skin incisions were made superior to the eyebrow in six studies. 33,34,[41][42][43][44] A skin incision within the hair of the eyebrow was made in nine studies. 7,39,40,[45][46][47][48][49][50] Endoscopic assistance was reported to be used in all patients in eight studies 7,40,41,[43][44][45][46][47][48] and in 25% (2/8) of cases in one study.…”

“…7,39,40,[45][46][47][48][49][50] Endoscopic assistance was reported to be used in all patients in eight studies 7,40,41,[43][44][45][46][47][48] and in 25% (2/8) of cases in one study. 41 Types of lesions undergoing minimally invasive supraorbital craniotomy include 55 craniopharyngiomas, 7,34,41 nine epidural hematomas, 42 six epidural abscesses, 33,40,42 one metastatic medulloblastoma, 42 one medulloblastoma, 7 one glioblastoma, 42 21 gliomas, 7,33,34 one J o u r n a l P r e -p r o o f frontal encephalocele, 42 33 arachnoid cysts, 34,44,45 eight dermoid tumors, 7,34,39,50 three hypothalamic hamartomas, 7,34 two neurenteric cysts, 7,47 two neuronal tumors, 34 one compound skull fracture, 7 one pituitary macroadenoma, 7 one cavernoma,…”

“…Two studies did not specifically report any cosmetic outcome. 44,48 In one study, postoperative scaring was reported to be noticeable at six to eight weeks follow up but not visible by the three to six month clinic visit. 34 Four studies reported that scarring was barely visible after six weeks.…”

“…Complications stratified by each individual study are displayed in Table 3. Three cases of CSF leak were reported, 7,44,50 with an additional five patients having subgaleal CSF collections. 41,44 Additional complications included one chronic subdural hematoma, 38,41 one subdural hygroma, 38,41 one epidural hematoma, 42 five patients with visual impairment, 7,34,41 one patient with seizures, 44 one patient with ansomia, 7 three postoperative wound infections, 33,34 and one case of postoperative meningitis.…”