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Shunting for the treatment of arachnoid cysts in children
George A Alexiou1, Maria Varela, George Sfakianos
1Department of Neurosurgery, Children's Hospital Agia Sofia, Athens, Greece. alexiougrg@yahoo.gr
Background:
The optimal treatment of symptomatic arachnoid cysts remains controversial.
Objective:
We present a single-institution experience on surgical treatment of arachnoid cysts.
Methods:
Between January 1983 and January 2008, 92 patients with symptomatic arachnoid cysts underwent surgery at our institute. All patients were evaluated with CT and/or MRI and were operated upon and had regular follow-up examinations.
Results:
There were 60 males and 32 females. The mean age was 3.6 years (range, 2 days to 14 years). Forty-eight cysts (52%) were within the sylvian fissure, 16 (17%) were in the cerebral convexity, 15 (16%) were infratentorial, 10 (11%) were in the interhemispheric fissure, and 3 (4%) were parasellar. Cystoperitoneal shunt was placed in 67 (73%) patients; ventricular drainage alone was performed in 14 (15%) patients; and combined drainage of the ventricular system and cyst, using a 3-way connector, was performed in 8 (9%) patients. Craniotomy and fenestration of the cyst was performed in 2 (2%) patients, whereas total excision of the cyst was performed in 1 patient. Shunt revision for various reasons was performed in 34 patients (39%), whereas 13 (14%) patients required more than one revision. Complete alleviation of symptoms was achieved in all patients after treatment, regardless of cyst reduction. After a mean follow-up of 8.5 years no further enlargement of the arachnoid cysts was noted.
Conclusion:
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.
