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Treatment of symptomatic sacral arachnoid cysts in the pediatric population
Insights
Symptomatic sacral arachnoid cysts in children are rare but can cause urinary issues and back pain. Surgery is effective for treating these cysts, with low complication rates.
Area of Science:
- Pediatric Neurosurgery
- Urology
- Spinal Imaging
Background:
- Sacral arachnoid cysts are rare in children, leading to uncertainty in treatment approaches.
- These cysts can manifest with symptoms like urinary incontinence, constipation, urinary tract infections, and low-back pain.
Purpose of the Study:
- To evaluate clinical symptoms, surgical indications, techniques, and outcomes for pediatric sacral arachnoid cysts.
- To develop recommendations for follow-up and treatment of these rare conditions.
Main Methods:
- Retrospective study of pediatric patients treated for sacral arachnoid cysts (2000-2020).
- Inclusion of 13 patients (9 female, 4 male).
- Clinical assessment, urological evaluation, urodynamic studies, and spinal MRI were performed. Cyst wall samples underwent pathological examination.
Main Results:
- Common symptoms included urinary incontinence, recurrent UTIs, and low-back pain.
- Surgical treatment led to symptom resolution in most patients (urinary incontinence, constipation, UTIs, back pain).
- One patient required reintervention due to recurrence; one patient had persistent back pain. No postoperative complications were noted. Mean follow-up was 4 years.
Conclusions:
- Pediatric sacral arachnoid cysts are linked to urinary dysfunction and low-back pain.
- Surgery is the preferred treatment for symptomatic or radiologically compressive cysts.
- Surgical intervention for sacral arachnoid cysts in children has low morbidity and mortality rates.
Objective:
Symptomatic sacral arachnoid cysts are extremely rare in pediatric patients, resulting in a lack of consensus regarding optimal treatment measures. The current study evaluated the clinical symptoms and surgical indications, techniques, and outcomes of pediatric patients who underwent treatment for sacral arachnoid cysts with the aim of developing recommendations for follow-up and treatment.
Methods:
This retrospective study included pediatric patients who underwent surgical treatment for sacral arachnoid cysts between January 2000 and December 2020 at the Department of Pediatric Neurosurgery, Acıbadem University Faculty of Medicine.
Results:
Thirteen patients were included in the study, 9 of whom were girls and 4 were boys. Five patients presented with urinary incontinence, 2 of whom also exhibited constipation. Other chief complaints included recurrent urinary tract infections (UTIs) and low-back pain (n = 4 patients each). Urological evaluation was performed in all patients, followed by urodynamic examination in those with urinary symptoms. Spinal MRI showed extra- and intradural sacral cysts in 12 patients and 1 patient, respectively. The latter patient exhibited recurrence during follow-up and underwent reintervention. Samples from the excised cyst walls were sent for pathological examination. Five patients with urinary incontinence, 2 with constipation, 4 with recurrent UTIs, and 3 with low-back pain exhibited resolution of symptoms after treatment. However, 1 patient with low-back pain did not show any improvement in symptoms. No postoperative complications were observed in the current study. The patients were followed-up regularly after surgery, and the mean follow-up duration was 4 years.
Conclusions:
Sacral arachnoid cysts in pediatric patients may be associated with urinary system dysfunction and low-back pain. Surgery is the treatment of choice for symptomatic patients and those with enlarged cysts with radiological evidence of compression, and the morbidity and mortality rates associated with surgery are low.
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