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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Surgical treatment of symptomatic arachnoid cysts in children]
P Pulido-Rivas1, F J Villarejo-Ortega, F Cordobés-Tapia
1Servicio de Neurocirugía, Hospital Niño Jesús, Madrid, Spain. ppulido@neurorgs.com
Insights
Symptomatic arachnoid cysts (AC) in children require surgery. While cyst-peritoneal shunts (CPS) have lower initial risk, endoscopic techniques show promise despite higher reintervention rates for some AC treatments.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Cystic Lesions
Context:
- Symptomatic arachnoid cysts (AC) necessitate surgical intervention.
- Optimal surgical management for pediatric AC remains debated, with cyst-peritoneal shunts (CPS) and cyst fenestration (craniotomy or endoscopic) as primary options.
Purpose:
- To evaluate surgical outcomes for symptomatic arachnoid cysts in pediatric patients.
- To compare the efficacy and complications of different surgical techniques for pediatric AC.
Summary:
- This study analyzed 18 pediatric patients (<10 years) with symptomatic ACs treated via CPS (12 cases), endoscopic fenestration (5 cases), or craniotomy (1 case).
- Seven patients required reintervention due to shunt malfunction or insufficient endoscopic treatment. Complications included two subdural hematomas; no mortality or morbidity was observed.
Impact:
- Endoscopic techniques are advancing and may become preferred over craniotomy for AC treatment.
- CPS offers lower initial surgical risk but carries a high reintervention rate and shunt dependency. Further research is needed for optimal management in infants.
Introduction:
When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy -implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques.
Patients And Methods:
This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial.
Results:
Treatment involved a cyst-peritoneal or ventriculoperitoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred.
Conclusions:
The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts.
