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Hydrocephalus in children with middle fossa arachnoid cysts

Michael L Levy1, Hal S Meltzer, Samuel Hughes

  • 1Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut 92123, USA. mlevy@chsd.org

Journal of Neurosurgery
|October 7, 2005
PubMed

Insights

Children with middle fossa arachnoid cysts (MFACs) often need cerebrospinal fluid (CSF) shunts alongside cyst fenestration, especially if hydrocephalus or macrocephaly is present. Nonspecific macrocephaly may indicate underlying CSF circulation issues.

Area of Science:

  • Pediatric Neurosurgery
  • Neurology
  • Cerebrospinal Fluid Dynamics

Background:

  • Management of middle fossa arachnoid cysts (MFACs) in children is debated.
  • Preoperative factors like hydrocephalus and macrocephaly may influence treatment outcomes.
  • Fenestration and CSF diversion are common interventions for symptomatic MFACs.

Purpose of the Study:

  • To evaluate the relationship between hydrocephalus, nonspecific macrocephaly, and the need for cerebrospinal fluid (CSF) shunt placement in children undergoing fenestration for MFACs.
  • To assess the necessity of ventriculoperitoneal (VP) shunts in conjunction with cyst fenestration for pediatric MFACs.
  • To investigate potential underlying CSF circulation derangements in children with nonspecific macrocephaly.

Main Methods:

  • Retrospective analysis of 40 children with MFACs treated over 16 years.
  • Evaluation of preoperative variables: hydrocephalus and nonspecific macrocephaly.
  • Assessment of surgical procedures (cyst fenestration, VP shunt placement) and outcomes.

Main Results:

  • All but one patient required intervention due to worsening symptoms or cyst enlargement.
  • Six patients presented with hydrocephalus and nine with nonspecific macrocephaly.
  • Patients with hydrocephalus required VP shunt placement along with fenestration; five with macrocephaly needed subsequent VP shunts.

Conclusions:

  • Hydrocephalus or macrocephaly in pediatric MFACs strongly predicts the need for VP shunt placement in addition to cyst fenestration.
  • Nonspecific macrocephaly may suggest an underlying, latent disturbance in CSF circulation.
  • Combined surgical approaches are often necessary for optimal management of complex pediatric MFAC cases.
Abstract

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