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Published on: August 11, 2015
The effectiveness of microsurgical fenestration for middle fossa arachnoid cysts in children
Atsushi Okano1, Hideki Ogiwara2
1Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
Objective:
Although middle fossa arachnoid cysts (MFACs) are common, the optimal surgical treatment for these lesions remains controversial. In this study, we present our experiences of treating MFACs by microsurgical fenestration and evaluate its effectiveness.
Methods:
We performed retrospective review of 28 patients who underwent microsurgical fenestration for MFACs between May 2003 and December 2014. We reviewed patient characteristics and treatment outcomes including age, sex, symptoms, complicating hydrocephalus, Gallasi classification, change in cyst size after surgery, complicating subdural hygroma, symptom resolution, regrowth of the cyst, and reoperation (including additional CSF diversion).
Results:
Twenty-eight MFACs in 28 patients were investigated. The average age at the time of surgery was 61.6 months. The average follow-up duration was 53.5 months. After surgery, 19 (90.5 %) of 21 patients with symptomatic MFACs experienced improvements. The cysts decreased in size in all cases (100 %, 28/28) and disappeared in three cases (11 %, 3/28). None of the cases experienced regrowth of the cyst. Subdural hygroma was identified in 23 cases (82.1 %) at the immediate postoperative period. Hygroma was asymptomatic in all cases but one. Hygroma disappeared in 19 cases (83 %) and decreased in size in three cases (13 %) in the long term. Only one case (4 %) required an additional subdural-peritoneal shunt. The rate of CSF diversion after the fenestration was significantly higher in patients with preoperative ventricular dilation (p = 0.0002).
Conclusion:
Microsurgical fenestration for pediatric MFACs was considered to be safe and effective. Although subdural hygroma developed in significant number of patients at the immediate postoperative period, it was mostly asymptomatic and disappeared or decreased in size in the long term.
Insights
Microsurgical fenestration is a safe and effective treatment for pediatric middle fossa arachnoid cysts (MFACs). This procedure led to symptom improvement in most patients and cyst size reduction, with minimal long-term complications.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Cranial Surgery
Background:
- Middle fossa arachnoid cysts (MFACs) are common intracranial lesions in children.
- The optimal surgical management for MFACs remains a subject of debate.
- Microsurgical fenestration is one approach to treating these cysts.
Purpose of the Study:
- To evaluate the safety and effectiveness of microsurgical fenestration for pediatric MFACs.
- To assess treatment outcomes including cyst resolution, symptom improvement, and complications.
Main Methods:
- Retrospective review of 28 pediatric patients with MFACs treated between 2003 and 2014.
- Analysis of patient demographics, clinical presentation, surgical technique, and postoperative outcomes.
- Evaluation of cyst size changes, symptom resolution, and development of complications like subdural hygroma.
Main Results:
- Symptomatic improvement was observed in 90.5% of patients post-fenestration.
- All cysts showed decreased size, with complete resolution in 11% of cases.
- Subdural hygroma occurred postoperatively in 82.1% but was mostly asymptomatic and resolved over time.
Conclusions:
- Microsurgical fenestration is a safe and effective treatment for pediatric MFACs.
- The procedure leads to significant cyst reduction and symptom relief.
- Postoperative subdural hygroma is common but generally transient and manageable.
