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Surgery for intracranial arachnoid cysts in children-a prospective long-term study
Katrin Rabiei1,2, Mats Johansson Högfeldt3, Roberto Doria-Medina4
1Department of Neurosurgery, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden. katrin.rabiei_tabriz@vgregion.se.
Insights
Surgical intervention for pediatric intracranial arachnoid cysts shows symptom improvement in most patients long-term. However, a restrictive approach is advised unless symptoms are objectively verified or CSF pathways are obstructed.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Cystic Malformations
Background:
- Intracranial arachnoid cysts are common in children, often asymptomatic.
- Symptomatic cysts may require surgical intervention.
- Outcomes of surgical treatment in pediatric populations require further investigation.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of surgical interventions for intracranial arachnoid cysts in children.
- To assess symptom improvement and cyst volume changes postoperatively.
- To inform surgical decision-making for pediatric arachnoid cysts.
Main Methods:
- Prospective, population-based study of 27 pediatric patients with de novo arachnoid cysts.
- Surgical treatments included microsurgical or endoscopic fenestration.
- Cyst volume measured pre- and postoperatively; clinical follow-up at 3 months and 8.6 years.
Main Results:
- 59% of patients showed improvement in at least one major complaint at 3 months.
- 77% of patients improved symptomatically at long-term follow-up (8.6 years).
- No association found between cyst volume reduction and clinical improvement; no permanent morbidity.
Conclusions:
- Surgical intervention can lead to symptom improvement in pediatric intracranial arachnoid cysts.
- A restrictive surgical approach is recommended for cysts without objectively verified symptoms or CSF obstruction.
- Further research may explore factors predicting surgical success.
Purpose:
Intracranial arachnoid cysts are cystic malformations found in both adults and children. While many are asymptomatic, some cause symptoms and warrant surgical treatment. In this prospective population-based study, we aimed to study the short- and long-term outcome after surgical intervention in children with arachnoid cysts referred to our centre.
Methods:
Twenty-seven pediatric patients (13 f. 14 m, mean age 9.4 years) with de novo cysts were consecutively included during a 5-year period. The presenting symptoms were headache (n = 12), balance disturbance and dizziness (n = 6), seizures (n = 6), hydrocephalus (n = 5), and macrocephaly (n = 1). Twenty-two patients underwent surgical treatment with either microsurgical (n = 17) or endoscopic fenestration (n = 5) of the cyst wall. Cyst volume was measured with OsiriX® software pre- and postoperatively. Short-term and long-term follow-up of all patients was conducted 3 months and 8.6 years (7-10.5 years) postoperatively.
Results:
Three months after surgery, 59 % of the patients were improved regarding at least one major complaint, and average cyst volume was reduced to 33.3 ml (0-145 ml). At the long-term follow-up of 8.6 years, 77 % of the patients were improved regarding at least one symptom but subjective symptoms remained in 59 %. There was no permanent postoperative morbidity. We found no association between radiological reduction of cyst volume and clinical improvement.
Conclusion:
Our findings support a restrictive attitude to surgery for intracranial arachnoid cysts, in the absence of objectively verified symptoms and signs or obstruction of CSF pathways.
