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

Journal article
Authors Katrin Rabiei
Mats Högfeldt Johansson
Roberto Doria Medina
Magnus Tisell
Published in Child's Nervous System
Volume 32
Pages 1257-1263
ISSN 0256-7040
Publication year 2016
Published at Institute of Neuroscience and Physiology
Pages 1257-1263
Language en
Links doi.org/10.1007/s00381-016-3064-8
Keywords Arachnoid cysts, Cyst volume, Long-term outcome, Radiological versus clinical improvement
Subject categories Pediatric surgery, Neurosciences

Abstract

© 2016, Springer-Verlag Berlin Heidelberg. Purpose: 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. Methods: Twenty-seven pediatric patients (13 f. 14 m, mean age 9.4 years) 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 3 months and 8.6 years (7–10.5 years) postoperatively. Results: Three months after surgery, 59 % of the patients were improved regarding at least one major complaint, and average cyst volume was reduced to 33.3 ml (0–145 ml). At the long-term follow-up of 8.6 years, 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. Conclusion: 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.

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