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Large arachnoid cysts at the cranial base
Insights
Large cranial base arachnoid cysts in infants can cause brain displacement. Simple cystoperitoneal shunting offers a promising treatment option with good long-term outcomes for these macrocephaly cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Radiology
Background:
- Macrocephaly in infants can be associated with large cranial base cysts.
- Noncommunicating cysts at the cranial base can displace brain structures, leading to neurological deficits.
Observation:
- Two infants presented with macrocephaly due to large, bilateral, noncommunicating cranial base arachnoid cysts.
- One infant developed hydrocephalus requiring ventriculoperitoneal shunting; the other received a cystoperitoneal shunt.
Findings:
- Both infants demonstrated positive outcomes following surgical intervention, with follow-up periods of 4 and 6 years.
- These large arachnoid cysts pose risks of severe surgical complications and uncertain cure rates.
Implications:
- Systematic radiological investigation, including radionuclide cisternography and cystography, is recommended for diagnosis and therapeutic planning.
- Simple cystoperitoneal shunting may be the preferred treatment for many large cranial base arachnoid cysts in infants.
Abstract:
Two infants who presented with macrocephaly had very large noncommunicating cysts at the cranial base that were displacing the brain. Only one of the patients was hydrocephalic; he eventually underwent ventriculoperitoneal shunting after craniotomy and attempted internal drainage of the cyst. The other infant had a cystoperitoneal shunt. Both have done well after 4 and 6 years of follow-up, respectively. These large arachnoid cysts are bilateral lesions with the potential for severe surgical complications and a questionable possibility of cure. The authors recommend systematic radiological investigation to decide the appropriate therapy, including an analysis of the patency of the subarachnoid pathways with radionuclide cisternography and cystography. Simple cystoperitoneal shunting may be the appropriate therapy for most of these large lesions. (Neurosurgery, 6: 76--81, 1980).