Paediatric arachnoid cysts: Surgical outcomes from a Singapore children's hospital
Jasmine L Chan1, Audrey L J Tan2, Lee Ping Ng1
1Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
Insights
Pediatric arachnoid cysts (AC) can cause serious symptoms. This study reviews 38 surgical cases, finding surgical approaches varied, with some patients needing reoperation, highlighting the need for better understanding of AC management.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Cystic Lesions
Background:
- Arachnoid cysts (AC) affect up to 2.6% of children, with some causing significant intracranial pressure.
- Management of pediatric ACs involves controversial decisions regarding surgical indications and procedures.
Purpose of the Study:
- To report a single institution's 22-year neurosurgical experience with symptomatic pediatric arachnoid cysts.
- To compare institutional findings with existing literature on AC management.
Main Methods:
- Retrospective study of 38 pediatric patients with surgically treated ACs from 1998-2019.
- Analysis of cyst location, clinical presentation, surgical techniques, and patient outcomes.
Main Results:
- The most common locations were middle cranial fossa (40.5%), posterior fossa (24.3%), and interhemispheric (13.5%).
- Presentations included raised intracranial pressure (34.2%), hydrocephalus (28.9%), and cyst rupture (21.1%).
- 34.2% of patients required reoperation due to persistent symptoms or complications; average follow-up was 84.1 months.
Conclusions:
- Institutional experience aligns with larger cohort studies regarding AC epidemiology and presentation.
- Further research is needed to understand AC pathophysiology and guide surgical treatment modality selection.
Abstract:
Arachnoid cysts (AC) are reported to have a prevalence of up to 2.6% in children. Most AC remain indolent, but others may expand or rupture to cause life-threatening symptoms of raised intracranial pressure. Currently, there are 2 controversial topics with regards to the management of ACs: the indications for surgery and the choice of surgical procedure. We therein report our institution's neurosurgical experience for symptomatic AC over a 22-year period and corroborate our results with published literature. This is a single institution, retrospective study conducted at KK Women's and Children's Hospital from 01 January 1998 to 31 December 2019. A total of 38 patients with ACs that required surgery were recruited. The 3 most common anatomical locations were in the middle cranial fossa (40.5%), posterior fossa (24.3%) and interhemispheric (13.5%). Typical clinical presentations included symptoms of raised intracranial pressure (34.2%), obstructive hydrocephalus (28.9%) and AC rupture (21.1%). Surgical approaches included 17 craniotomy-based procedures, 7 endoscopic fenestrations, 11 cystoperitoneal shunts, 2 burrhole drainage operations and 1 excision of spinal AC. Thirteen patients (34.2%) underwent either another operation due to the lack of resolution of their AC-related symptoms or secondary to complications directly related to their initial surgery. Average length of followup from time of first operation was 84.1 months. Overall, our results demonstrate similarities in epidemiology, clinical presentation and surgical experience, in comparison to larger cohort studies. We advocate collaborative efforts to better understanding of the pathophysiology of paediatric ACs, particularly for deciding between the various surgical treatment modalities.
