Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period.

Abstract

Less than 0.5% of arachnoid cysts are intraventricular in origin. We review our experience with endoscopic surgery for intraventricular arachnoid cysts in children. This is a retrospective review of children with intraventricular arachnoid cysts who underwent surgery between 2005 and 2016. Clinical notes and imaging were reviewed. Twenty-nine patients with endoscopically treated intraventricular arachnoid cysts were identified (M/F=17:12; median age=1.47years, range=7days-13years). All had hydrocephalus at presentation, many had symptoms/signs of raised intracranial pressure, and five (17%) were asymptomatic. Cysts were treated with fenestration into the ventricle alone (ventriculocystostomy [VC], n=14), fenestration into the ventricle and cisternostomy (ventriculocystostomy plus cisternostomy [VC+C], n=14), or endoscopic third ventriculostomy alone (n=1). Six (21%) patients experienced transient and/or conservatively managed complications. Further surgery was required in 12 (41%). Revision-free survival was significantly shorter with VC compared to VC+C (log rank p=0.049), and the majority of VC/VC+C revisions (n=8 of 11, 73%) were required within 6months of initial endoscopic surgery. One (3%) patient died during follow-up, from unrelated pathology. After a median follow-up of 67.5months in survivors (range=5.5-133.5months), 24 (83%) cases were clinically and radiologically stable without a shunt in situ. Endoscopic fenestration is safe and effective in most intraventricular arachnoid cysts. Additional cisternostomy at the time of cyst fenestration into the ventricle significantly improved revision-free survival in our cohort. Endoscopic surgery should be the first-line therapy when considering intervention for symptomatic intraventricular arachnoid cysts and for asymptomatic cysts increasing in size on serial imaging.