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Systematic review of pineal cysts surgery in pediatric patients
Joham Choque-Velasquez1,2, Roberto Colasanti3,4, Szymon Baluszek5,6
1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland. johchove@hotmail.com.
Insights
Pediatric arachnoid cysts (PCs) appear to be progressive, often leading to hydrocephalus. Microsurgery offers better outcomes and more complete resection for these pediatric brain cysts.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Research
Background:
- Arachnoid cysts (PCs) are a significant concern in pediatric neurosurgery.
- The progressive nature and optimal surgical management of pediatric PCs require further elucidation.
Purpose of the Study:
- To investigate the natural history of pediatric arachnoid cysts (PCs).
- To evaluate the efficacy of microsurgery versus other treatments for pediatric PCs.
Main Methods:
- A systematic review of PubMed and Scopus databases was performed.
- Individual patient data from 43 articles (22 case reports, 21 observational series) involving 109 pediatric PC patients were analyzed.
Main Results:
- Pediatric PCs demonstrated progressive growth, correlating with symptom severity and leading to hydrocephalus (mean cyst diameter 23.5 mm).
- Younger patients (≤10 years) had smaller cysts compared to older children.
- Microsurgery resulted in superior gross total resection rates (p < 0.001) and 96% of patients experienced symptom improvement or resolution post-surgery.
Conclusions:
- Surgically treated pediatric PCs exhibit progressive behavior, often culminating in hydrocephalus.
- PC microsurgery is associated with more complete resection and favorable outcomes compared to endoscopic or stereotactic procedures.
Introduction:
We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments.
Methods:
The systematic review was conducted in PubMed and Scopus. No clinical study on pediatric PC patients was available. We performed a comprehensive evaluation of the available individual patient data of 43 (22 case reports and 21 observational series) articles.
Results:
The review included 109 patients (72% females). Ten-year-old or younger patients harbored smaller PC sizes compared to older patients (p < 0.01). The pediatric PCs operated on appeared to represent a progressive disease, which started with unspecific symptoms with a mean cyst diameter of 14.5 mm, and progressed to visual impairment with a mean cyst diameter of 17.8 mm, and hydrocephalus with a mean cyst diameter of 23.5 mm in the final stages of disease (p < 0.001). Additionally, 96% of patients saw an improvement in their symptoms or became asymptomatic after surgery. PC microsurgery linked with superior gross total resection compared to endoscopic and stereotactic procedures (p < 0.001).
Conclusions:
Surgically treated pediatric PCs appear to behave as a progressive disease, which starts with cyst diameters of approximately 15 mm and develops with acute or progressive hydrocephalus at the final stage. PC microneurosurgery appears to be associated with a more complete surgical resection compared to other procedures.
