Intracranial Arachnoid Cysts In Children Research Articles

In Reply to the Letter to the Editor Regarding “Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children”

In Reply to the Letter to the Editor Regarding “Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children”

Letter to the Editor Regarding: Factors That Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

Letter to the Editor Regarding: Factors That Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

This study aimed to investigate factors that influence subdural haemorrhage (SDH) secondary to intracranial arachnoid cysts (IACs) in children. Data of children with unruptured IACs (IAC group) and those with SDH secondary to IACs (IAC-SDH group) were analyzed. Nine factors, sex, age, birth type (vaginal or caesarean), symptoms, side (left, right, or midline), location (temporal or nontemporal), image type (I, II, or III), volume, and maximal diameter, were selected. IACs were classified as types I, II, and III according to their morphological changes observed on computed tomography images. There were 117 boys (74.5%) and 40 girls (25.5%); 144 (91.7%) patients comprised the IAC group and 13 (8.3%) comprised the IAC-SDH group. There were 85 (53.8%) IACs on the left side, 53 (33.5%) on the right side, 20 (12.7%) in the midline region, and 91 (58.0%) in the temporal region. The univariate analysis showed significant differences in age, birth type, symptoms, cyst location, cyst volume, and cyst maximal diameter (P<0.05) between the 2 groups. Logistic regression using the synthetic minority oversampling technique model showed that image type III and birth type were independent factors that influenced SDH secondary to IACs (β0=4.143; β for image type=-3.979; β for birth type=-2.542) and that the representative area under the receiver-operating characteristic curve value was 0.948 (95% confidence interval, 0.898-0.997). IACs are more common in boys than in girls. They can be divided into 3 groups according to their morphological changes on computed tomography images. Image type III and caesarean delivery were independent factors that influenced SDH secondary to IACs.

Why neuroendoscopy is not for all supratentorial intracranial arachnoid cysts in children: analysis of risk factors and prognosis

Cerebral neuroendoscopy is a minimally invasive approach that reduces brain exposure, retraction and mobilization of neural tissues and neurovascular structures and the treatment of intracranial arachnoid cysts by endoscopy has been widely used. Selection of the patients who are most likely to benefit remains challenging in certain cases. The purpose of this article is to raise questions and observations regarding its indication and failure in pediatric patients with suprasellar, and middle fossa arachnoid cysts. We searched English-language articles published in the last 20 years and found evidence that Neuroendoscopy emerged as an alternative to the treatment of this pathology and has its definitive role as a safe, less morbid strategy in these supratentorial pediatric arachnoid cysts and must be added to the therapeutic protocols respecting the best indication.

Clinical variety and prognosis of intracranial arachnoid cysts in children.

Arachnoid cysts (AC) occur in different intracranial locations. Management and prognosis depend on the clinical presentation and treatment guidelines do not exist. With this study, we want to demonstrate the clinical variety of arachnoid cysts in children and place a focus on outcome factors in operated cases. This retrospective study of a consecutive single unit series of children, who underwent AC surgery between January 2010 and September 2019, provides demographic, clinical, imaging data, and information about surgical treatment and outcome. Overall, 63 patients (71.4 male) underwent surgery. Mean age was 50months (0-191). Mean follow-up was 40months (0-121). Eighty-one percent of patients presented with symptoms/signs of raised ICP. Focal neurological deficits were present in 15.9%, headache in 11.1% of children. Galassi cysts represented the predominant type (30.2%), followed by suprasellar (14.3%), quadrigeminal (12.7%), retrocerebellar, CPA and midline (each 11.1%), and hemispheric cysts (7.9%). Endoscopic and microsurgical fenestrations were performed in 27% and 58.7%, stent or shunt insertion in 6.3%/57.9% of the cases. In 33.3% of the cases one and in 12.7%, a second reintervention became necessary. Reoperation rate was significantly higher in children < 1year (p = 0.003). Cyst volume decreased in 85.7%. Seventy percent of the patients were symptom free, 5% suffered from headache, and 22% from developmental disorders. All focal neurological symptoms resolved. Complication rate and outcome are depending on age and cyst location. Recurrence and revision rates are significantly higher in young infants (p = 0.003). Midline cysts with CCA are associated with developmental disorders.

Cystoventricular Drainage of Intracranial Arachnoid Cysts in Adults

Intracranial arachnoid cysts (ACs) are generally benign fluid-filled cysts with a prevalence of 0.5%-2.7%. They can be treated through craniotomy with cyst removal, endoscopic fenestration, or cystoperitoneal or ventriculoperitoneal shunting. However, the outcome of these treatments has not been completely satisfactory. Cystoventricular shunting was described as an alternative method for the treatment of intracranial ACs in children in 2003. In the present report, we have described the outcomes of cystoventricular shunting in adults with symptomatic intracranial ACs. A total of 24 patients with symptomatic ACs underwent cystoventricular drainage from 2012 to 2019. The most common symptom preoperatively was headache, followed by dysphasia, motor weakness, memory loss, seizures, and balance disturbances. After radiological evaluation, a ventricular catheter was placed in the AC and another in one of the lateral ventricles and connected extracranially after subgaleal tunneling using a straight metal connector. At 3-6 months of postoperative follow-up, 21% of patients were asymptomatic and 42% showed improvement in clinical symptoms. No patient had experienced impairment or progression of symptoms postoperatively. Three patients had required revision of the catheters and one patient had developed a postoperative superficial skin infection without signs of deeper infection. Cystoventricular drainage seems to be an effective, reliable, and safe procedure to treat intracranial ACs when fenestration to the basal cisterns is not possible.

Neuroendoscopic cisternostomy for the treatment of pediatric intracranial arachnoid cysts

Objective To evaluate the clinical efficacy of neuroendoscopic cisternostomy for the treatment of intracranial arachnoid cysts (IACs) in children. Methods Thirty-one children in total with IACs who underwent neuroendoscopic cisternostomy from January 2010 to August 2017 at Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled. All cases were followed up in the aspect of clinical efficacy. Results Among 31 children, the improvement rate of clinical symptoms was 91.0% (20/22) in symptomatic patients after operation. The follow-up period ranged from 13 to 36 months, with an average of 21.0±5.6 months. Compared with preoperative data (Mean: 52.5 ml; P25, P75: 31.3 ml, 167.6 ml), the means of shrinkage rates of cyst volume at 3 months (Mean: 27.8 ml; P25, P75: 15.6 ml, 42.3 ml) and 12 months (Mean: 22.5 ml; P25, P75: 13.9 ml, 34.9 ml) post operation were 62.5+ 15.7% and 68.3+ 12.8% respectively with significant statistical differences (all P<0.05). Complications occurred in 7 (22.6%) cases during perioperative period, including fever in 2, subdural effusion in 3 (volume of effusion decreased significantly in 3 months and disappeared in 12 months after operation without obvious symptoms or particular treatment) and subcutaneous effusion in 2 cases. During the follow-up period, only 1 (3.2%) child developed intractable subcutaneous effusion. Conclusion Neuroendoscopic cisternostomy for the treatment of IACs in children seems safe and effective. Key words: Natural orifice endoscopic surgery; Arachnoid cysts; Child; Cystocisternotomy

3D Modeling for Comparison of Surgically Treated Intracranial Arachnoid Cysts in Children

3D Modeling for Comparison of Surgically Treated Intracranial Arachnoid Cysts in Children

Natural History and Treatment Strategy for Intracranial Arachnoid Cysts in Children

Natural History and Treatment Strategy for Intracranial Arachnoid Cysts in Children

Ruptured intracranial arachnoid cysts presented with subdural effusion or hematoma in children: clinical feature analysis and treatment outcome

Objective To analyze the clinical features, treatment strategies and outcome of ruptured intracranial arachnoid cysts(IACs) with subdural effusions or hematoma in children. Methods From January 2003 to January 2016, 49 ruptured IACs presented with subdural effusions, subdual and/or intracystic hematoma were retrospectively reviewed at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. The operative methods including burr hole in 16 cases, craniotomy and fenestration in 5 cases, cysto-peritoneal shunt (CPS) in 20cases, were indicated according to symptomatic presentation or significant radiological criteria. Eight cases were treated conservatively. Results The average age of the patients was 7.2±4.7 years, with the dominance of male(78%) and Galassi typeⅡ(53%) middle fossa(94%) IACs. The traumatic history was provided in 26(53%) cases. Raptured IAC were manifested as subdual and/or intracystic hemorrhage in 27(55%) and subdural effusion in 22(45%) patients. After a mean follow-up of 59.1 months in 47 patients, 3 cases disappeared spontaneously, 0 increased in size and all patients have symptomatic improvement. However, 14 of 30 burr hole need reoperation, with craniotomy in 4 and CPS in 10 cases. Shunt dependency occurred in 2 of 19 CPS (11%) and shunt revision was performed in 5(26%) CPS until the utility of programmable valves. Conclusion Subdural effusion or hematoma are probably supposed to have an underling IACs in children. Patients with raptured IACs can be treated conservatively in asymptomatic cases. As first procedure, burr hole and subdural drainage should be performed. Craniotomy or CPS should be reserved as the choice for special cases as alternative treatment. Programmable valves may contribute to decrease complications of CPS. Key words: Arachnoid cysts; Hematoma, subdural; Subdural effusion; Burr hole drainage; Cysto-peritoneal shunts

Surgery for intracranial arachnoid cysts in children—a prospective long-term study

Intracranial arachnoid cysts are cystic malformations found in both adults and children. While many are asymptomatic, some cause symptoms and warrant surgical treatment. In this prospective population-based study, we aimed to study the short- and long-term outcome after surgical intervention in children with arachnoid cysts referred to our centre. Twenty-seven pediatric patients (13 f. 14 m, mean age 9.4years) with de novo cysts were consecutively included during a 5-year period. The presenting symptoms were headache (n=12), balance disturbance and dizziness (n=6), seizures (n=6), hydrocephalus (n=5), and macrocephaly (n=1). Twenty-two patients underwent surgical treatment with either microsurgical (n=17) or endoscopic fenestration (n=5) of the cyst wall. Cyst volume was measured with OsiriX® software pre- and postoperatively. Short-term and long-term follow-up of all patients was conducted 3months and 8.6years (7-10.5years) postoperatively. Three months after surgery, 59% of the patients were improved regarding at least one major complaint, and average cyst volume was reduced to 33.3ml (0-145ml). At the long-term follow-up of 8.6years, 77% of the patients were improved regarding at least one symptom but subjective symptoms remained in 59%. There was no permanent postoperative morbidity. We found no association between radiological reduction of cyst volume and clinical improvement. Our findings support a restrictive attitude to surgery for intracranial arachnoid cysts, in the absence of objectively verified symptoms and signs or obstruction of CSF pathways.

Quistes aracnoideos intracraneales. Estudio de una serie de 35 casos

Arachnoid cysts are cavities with a content similar to cerebrospinal fluid, frequently communicating with the subarachnoid space. They make up 1% of the intracranial space occupying lesions, and although typically seen in children (13%), they may be undiagnosed until the patient has become adult. We review a series of 35 cases of congenital intracranial arachnoid cysts in children, which had been investigated in the Neuropaediatric Department during 1987 1999. The patients had had cranial CAT and MR, and transcranial echography studies. In 85.7% there was a single cyst. The Sylvan fissure and posterior fossa were the commonest sites. The age of diagnosis was under 1 year in 54.3% and at birth in 25.7%. There were other associated malformations of the central nervous system in 31.4%, with agenesis of the corpus callosum in 45.5%. The most frequent clinical features on presentation of the condition were macrocephaly (31.4%) and epileptic crises (25.7%). The surgical treatment most often used was cystoperitoneal shunt. Congenital arachnoid cysts are caused by alteration in the embryogenesis of the central nervous system, and hence their association with other malformations and prevalence in children. The most frequent clinical findings were macrocephaly, due to the size of the cyst or the associated hydrocephaly, and epileptic seizures secondary to cortical irritation caused by pressure. Management of symptomatic lesions is surgical. The cystoperitoneal shunt was generally used in our series, since this was followed by clinical improvement in most cases.

Intracranial arachnoid cysts in children: related signs and associated anomalies

Intracranial arachnoid cysts are benign development anomalies that may be clinically asymptomatic. The authors describe 30 children with intracranial arachnoid cysts in terms of clinical manifestations and relations to the associated brain anomalies or lesions. The mean age at onset of clinical manifestations was 4 years, 7 months (range 1 day to 14 years). The mean age at diagnosis was 6 years, 2 months (range 10 days to 16 years). Most patients with nonprogressive symptoms, such as seizures and headache, had focal epileptiform discharges on electroencephalogram, and they benefited from antiepileptic drugs. Surgery resulted in only partial reduction in both cyst size and seizure frequency in patients with intractable seizures, and it also failed to improve some neurologic signs, such as sexual precocity or cranial neuropathy resulting from long-term compression of arachnoid cysts. We conclude that the only absolute indication for surgery is the presence of progressive hydrocephalus or intracranial hypertension. The associated anomalies or lesions include brain tumors, giant nevocellular nevi, achondroplasia, microphthalmia, intracystic hemorrhage, dysgenesis of the corpus callosum, and heterotopia.

Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting

The best operative intervention for children with arachnoid cysts remains the subject of controversy. Recent reports stress that craniotomy for cyst fenestration is associated with a low incidence of morbidity and mortality and may leave the child shunt-independent. The cases of 40 pediatric patients with arachnoid cysts treated between 1978 and 1989 are reported. Five children with mild symptoms and small cysts that remained stable on follow-up studies have not required surgical intervention. Of 15 patients with cysts initially treated by fenestration, 10 (67%) showed no clinical or radiographic improvement postoperatively and have undergone cyst-peritoneal (eight patients) or ventriculoperitoneal (VP) shunting (one patient), or revision of a VP shunt placed for hydrocephalus before cyst fenestration (one patient). Two other patients with existing VP shunts required no further procedures. Thus, only three (20%) of 15 patients initially treated by fenestration remain shunt-independent after a median follow-up period of 8 years. The 20 other patients were initially treated by cysts shunting and all improved postoperatively; shunt revision has been necessary in six (30%) of these 20 patients because of cysts recurrence. Cyst location influenced the success of shunt treatment; none of the seven middle cranial fossa cysts treated by shunting have required revision, but results with cysts in other locations were less favorable. In all locations, though, shunting was more successful than fenestration. It is concluded that cyst-peritoneal or cyst-VP shunting is the procedure of choice for arachnoid cysts in most locations, including those in the middle cranial fossa.

An evaluation of the surgical treatment of intracranial arachnoid cysts in children.

In the period 1976-1987, the number of intracranial arachnoid cysts treated at our institute was 60: sylvian, 29; midline supratentorial, 13; subtentorial, 18. The diagnosis was mainly made by means of the results of a combination of CT, dynamic cisternography, and ventriculography. Based on an analysis of the preoperative investigations and operative results, an attempt was made to determine the appropriate treatment more precisely in cysts at different locations. The direct microsurgical approach with membrane excision was mainly used in combination with a preliminary VA shunt to treat hydrocephalus. The direct approach was supplemented with secondary cavity shunting in 5 cases. In more than half of the patients we used membrane excision alone (mainly children with sylvian cysts). In suprasellar cysts we consider the subfrontal approach to be more appropriate than the transventricular one. We restricted the use of primary cyst shunting as an alternative treatment to only 3 infants, with huge cysts. The follow-up reveals that 82.7% of the cases were favorable affected to varying degrees.

Intracranial Arachnoid Cysts in Children

Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112 Category: Congenital & Developmental • Pediatric

Intracranial arachnoid cysts in children.

The clinical and radiographic findings, surgical treatment, and outcome in 16 pediatric patients with intracranial arachnoid cysts are reviewed. The clinical presentation reflected the anatomical location of the lesions. Computerized tomography or magnetic resonance imaging scans were diagnostic in all cases. Of the nine cysts treated primarily or secondarily by craniotomy for fenestration and drainage into the basilar cisterns, five recurred. Cyst-peritoneal shunting led to diminished cyst size and clinical improvement in all seven cases in which it was used as the initial treatment and in all four cases in which fenestration had been unsuccessful. The results in this series show that cyst-peritoneal shunting is the treatment of choice for most intracranial arachnoid cysts in children.