Clinical features and surgical outcomes of pediatric intracranial arachnoid cysts: A report of 131 cases

Abstract

Objective To investigate the clinical features and surgical outcomes of pediatric intracranial arachnoid cysts (IAC). Methods A retrospective analysis was conducted on 131 children under 14 years old with IAC admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2011 to September 2016. Among them, 31 patients were asymptomatic. Initially, 57 patients underwent cystectomy or ostomy, and 13 patients underwent cyst-peritoneal shunt. Four patients underwent drilling and drainage with subdural hematoma or effusion. Follow-up was conducted for 57 cases. Results Of the 57 patients who were followed up, the median follow-up duration was 22 (3-48) months. Among them, 16 (28.1%) required surgery and included 14 patients undergoing cystectomy or ostomy and 2 undergoing cyst-peritoneal shunt. In 4 (7.0%) cases, cysts disappeared by themselves. No progression was reported in 26 cases. Slight enlargement was observed in 11 cases. There were 12 (29.3%) cases that were asymptomatic and 29 (70.7%) cases with mild symptoms. For the 90 children undergoing surgical treatment, the median follow-up period was 24 (3-56) months. Among them, there were 33 (36.7%) asymptomatic cases, 47 (52.2%) cases with mild symptoms and 10 (11.1%) cases with obvious symptoms. The size of postoperative cyst was 11.9±6.8 cm3, which was significantly smaller (P<0.05) than that prior to operation 138.5±26.1 cm3. Of the 71 patients who underwent cystectomy or ostomy, 11 (15.5%) had subdural effusion or hydrocephalus and 8 of whom were no more than 2 years old. Among the 15 patients who underwent cyst-peritoneal shunt, 3 developed shunt-dependent syndrome. Conclusions Patients observed during follow-up seem to have a relatively high chance of reoperation. Surgical operation, with satisfactory outcomes, might be the main method for the treatment of symptomatic IAC. Subdural effusion or hydrocephalus (mainly in children of no more than 2 years old) and shunt-dependent syndrome are main surgical complications. Key words: Child; Arachnoid cysts; Disease attributes; Treatment outcome; Postoperative complications