Endoscopic treatment of middle cranial fossa arachnoid cysts in children

Object Arachnoid cysts located in the middle cranial fossa are common, comprising about half of all intracranial arachnoid cysts. The management of these cysts is challenging, and the optimal surgical treatment is controversial. This study evaluates the role of endoscopy in the treatment of middle cranial fossa arachnoid cysts (MCFACs) in children, focusing on some factors or technical aspects that might influence the outcome. Methods Thirty-two children with symptomatic MCFACs were the subject of this study. The group included 23 boys and 9 girls, with a mean age of 3.6 years. All patients underwent operations using a purely endoscopic cystocisternostomy procedure through a transtemporal approach. Results Significant clinical improvement occurred in 28 cases (87.5%). Postoperative MR imaging showed a reduction in cyst size in 23 cases (71.9%), whereas in the remaining 9 cases (28.1%), the cyst size was unchanged. Minor intraoperative bleeding occurred in 3 cases (9.4%), which stopped spontaneously without any postoperative sequelae. Ipsilateral subdural hygroma occurred in 2 cases (6.3%) and resolved within a few weeks without surgery; transient oculomotor palsy occurred in 1 case (3.1%). During follow-up (mean 4.6 years), 3 patients (9.4%) experienced recurrence of symptoms and an increase in cyst size. Interestingly, all 3 patients who had recurrence had also experienced intraoperative bleeding at initial surgery. At a second endoscopic procedure, the fenestration was found to be closed in all 3 patients. Conclusions Endoscopic cystocisternostomy is recommended in the treatment of MCFACs in children because it is simple, minimally invasive, and effective. It maintains the basic strategy of cyst fenestration into the basal cisterns without the invasiveness of open craniotomy. This procedure reduces operative and recovery times and is associated with low morbidity and mortality rates.

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

Journal of Neurosurgery ◽

10.3171/jns.1991.74.2.0230 ◽

1991 ◽

Vol 74 (2) ◽

pp. 230-235 ◽

Cited By ~ 159

Author(s):

Samuel F. Ciricillo ◽

Philip H. Cogen ◽

Griffith R. Harsh ◽

Michael S. B. Edwards

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Shunt Revision ◽

Content Type ◽

Cyst Recurrence ◽

Cranial Fossa ◽

The Subject ◽

Low Incidence ◽

Cyst Fenestration

✓ 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 cyst shunting and all improved postoperatively; shunt revision has been necessary in six (30%) of these 20 patients because of cyst 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.

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Long-term Follow-up of a Multiloculated Arachnoid Cyst of the Middle Cranial Fossa

Ear Nose & Throat Journal ◽

10.1177/014556130708600611 ◽

2007 ◽

Vol 86 (6) ◽

pp. 338-341 ◽

Cited By ~ 2

Author(s):

Marc A. Cohen ◽

Noam A. Cohen ◽

Gul Moonis ◽

David W. Kennedy

Keyword(s):

Arachnoid Cyst ◽

Radiographic Progression ◽

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Close Observation ◽

Long Term Follow Up ◽

Intracranial Lesions ◽

Cranial Fossa

Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. We describe the case of a 56-year-old man who presented with a multiloculated arachnoid cyst of the middle cranial fossa that extended into the sphenoid sinus. The lesion was identified on computed tomography of the head, which had been obtained for an unrelated investigation. However, establishing a definitive diagnosis proved to be difficult. Because the cyst had caused extensive skull base erosion, the patient was managed conservatively with close observation. We report the radiographic progression of this lesion during more than a decade of follow-up, and we review the literature pertaining to the presentation, pathophysiology, and treatment of arachnoid cysts.

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Arachnoid cysts of the middle cranial fossa: a clinical, radiological and follow-up study

Acta Neurologica Scandinavica ◽

10.1111/j.1600-0404.1990.tb01595.x ◽

2009 ◽

Vol 82 (2) ◽

pp. 94-100 ◽

Cited By ~ 35

Author(s):

S. Passero ◽

G. Filosomi ◽

R. Cioni ◽

C. Venturi ◽

B. Volpini

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Follow Up Study ◽

Cranial Fossa

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Microsurgical, endoscopic, and shunt management of pediatric temporosylvian arachnoid cysts: a comparative study

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.12.peds18484 ◽

2019 ◽

Vol 23 (6) ◽

pp. 749-757 ◽

Cited By ~ 3

Author(s):

Aymeric Amelot ◽

Kevin Beccaria ◽

Thomas Blauwblomme ◽

Marie Bourgeois ◽

Giovanna Paternoster ◽

...

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Type I ◽

Percentage Decrease ◽

Cyst Volume ◽

Cranial Fossa ◽

Male Patients ◽

The Mean ◽

Cystoperitoneal Shunting

OBJECTIVEArachnoid cysts (ACs) are most frequently located in the middle cranial fossa. Some patients are asymptomatic whereas others exhibit signs of increased intracranial pressure, seizures, or cognitive and behavioral symptoms. When ACs do require treatment, the optimal surgical technique remains controversial. This study was conducted to assess the most effective surgical treatment for these cysts.METHODSThe authors retrospectively reviewed 240 temporal intracranial ACs managed over a 25-year period in their pediatric neurosurgical unit. Pre- and posttreatment results were clinically and radiologically assessed.RESULTSA majority of male patients (74.6%) with an overall median age of 6.9 years were included. The mean cyst size was 107 cm3; the Galassi classification showed 99 (41.3%) type I, 77 (32.1%) type II, and 64 (26.7%) type III cysts. Forty-four ACs (18.3%) were diagnosed after rupture. Surgical management was performed by microsurgery (28.3%), endoscopic cyst fenestration (14.6%), cystoperitoneal shunting (CPS; 16.2%), or subdural shunting (10%). Furthermore, 74 children (30.8%) did not undergo operations. After a mean follow-up of 4.1 years, the mean percentage decrease in cyst volume and the overall rate of clinical improvement did not significantly differ. The endoscopy group had earlier complications and a shorter event-free survival (EFS) time (EFS at 3 years = 67.7%, vs 71.5% and 90.5% for CPS and microsurgery, respectively; p < 0.007) and presented with more subdural hematomas compared to the microsurgery group (p < 0.005). The microsurgery group also showed a tendency for longer cystocisternostomy permeability than the endoscopy group.CONCLUSIONSConcerning the management of unruptured symptomatic temporal ACs, microsurgery appears to be the most effective treatment, with longer EFS and fewer complications compared to shunting or endoscopy.

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Endoscopic treatment of intraparenchymal arachnoid cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds13647 ◽

2014 ◽

Vol 14 (5) ◽

pp. 501-507 ◽

Cited By ~ 20

Author(s):

Nasser M. F. El-Ghandour

Keyword(s):

Subarachnoid Space ◽

Brain Parenchyma ◽

Arachnoid Cysts ◽

Third Ventriculostomy ◽

Cyst Size ◽

Significant Clinical Improvement ◽

Recovery Times ◽

Intracranial Lesions ◽

Ventricle Size ◽

Basal Cisterns

Object Arachnoid cysts account for 1% of all intracranial lesions. They usually occur in the subarachnoid space of the major cerebral fissures and arachnoid cisterns. They are very rarely located within the brain parenchyma devoid of communication with the subarachnoid space. The author of this study evaluated the role of endoscopy in the treatment of intraparenchymal arachnoid cysts (IPACs), which have a paraventricular location noncontiguous with the basal cisterns. Methods The records of all patients who had undergone surgery performed by one neurosurgeon between March 2004 and October 2011 were retrospectively reviewed to find cases of arachnoid cysts with a paraventricular location noncontiguous with the basal cisterns that were treated with a purely endoscopic cystoventriculostomy. Data were collected, summarized, and analyzed as regards improvement in symptomatology, decrease in cyst size, improvement in hydrocephalus, incidence of complications, surgical failure, and incidence of recurrence. Results Twelve pediatric patients with symptomatic IPACs were included in this study. The group included 7 boys and 5 girls with a mean age of 5.2 years. All of the patients had undergone endoscopic cystoventriculostomy. In addition, endoscopic third ventriculostomy had been performed during the same operative session in 3 patients who had associated hydrocephalus. Significant clinical improvement occurred in 10 patients (83.3%). Postoperative imaging showed a reduction in the cyst size in 9 patients (75%), whereas the cyst size was unchanged in the remaining 3 patients (25%). A reduction in ventricle size occurred in 2 (66.7%) of the 3 patients who had hydrocephalus. A postoperative subdural hygroma occurred in 2 patients (16.7%) and required the insertion of a subduroperitoneal shunt in 1 patient. During the follow-up period (mean 42.5 months), 1 patient had a recurrence and required a repeat endoscopic procedure. Conclusions Endoscopic cystoventriculostomy is recommended in the treatment of symptomatic IPACs. It maintains the basic strategy of cyst fenestration into the lateral ventricle without either the invasiveness of open craniotomy or the implantation of shunt systems. The procedure is simple, effective, and minimally invasive. It saves operative and recovery times and is associated with low morbidity and mortality rates.

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Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children

Child s Nervous System ◽

10.1007/s003810050024 ◽

2000 ◽

Vol 16 (2) ◽

pp. 111-116 ◽

Cited By ~ 54

Author(s):

J. -K. Kang ◽

K. S. Lee ◽

I. W. Lee ◽

S. S. Jeun ◽

B. C. Son ◽

...

Keyword(s):

Surgical Treatment ◽

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Cranial Fossa

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Endoscopic fenestration for treating Galassi type III middle cranial fossa arachnoid cysts: single- and multiple-stoma have the same curative effect

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/a-1712-5567 ◽

2021 ◽

Author(s):

Guangtong Zhu ◽

Chuzhong Li ◽

Songbai Gui ◽

Peng Zhao ◽

Zhenye Li ◽

...

Keyword(s):

Symptom Relief ◽

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Subdural Effusion ◽

Basal Cistern ◽

Curative Effect ◽

Invasive Approach ◽

Type Iii ◽

Cranial Fossa ◽

Endoscopic Fenestration

Background and Study Aims For endoscopic fenestration of middle cranial fossa arachnoid cysts (MCFACs), the decisions on the location and number of stomas are key issues in the operation. However, research on this particular topic has been limited. Thus, this study aimed to compare single-stoma versus multiple-stoma endoscopic fenestration for treating Galassi type III MCFACs. Patients and Methods This retrospective study included 86 patients with Galassi type III MCFACs treated with endoscopic fenestration. Single-stoma fenestration to the basal cistern was performed in 37 cases, while multiple-stoma fenestration to the basal cistern and the carotid cistern was performed in 49 cases. Clinico-radiological profiles and follow-up data were analyzed. Results The rate of symptom relief was 83.7%(72/86), and the rate of cyst shrinkage was 96.5%(83/86). Postoperative ipsilateral subdural effusion, which was significant(P=0.042), and non-infectious fever were the two most common complications in the single-stoma and multiple-stoma groups. No significant differences in intraoperative nerve injury, vascular injury, proportion of cases with cyst reduction, and symptom remission rate were observed between both groups. The rates of cyst recurrence and secondary surgery in the single-stoma group were higher than those in the multiple-stoma group, although the difference was not significant. Conclusion Endoscopic fenestration is an effective and minimally invasive approach for treating Galassi type III MCFACs. Single-stoma and multiple-stoma have the same curative effect.

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Arachnoid cysts

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0096 ◽

2019 ◽

pp. 1101-1106

Author(s):

Ruichong Ma ◽

Stana Bojanic

Keyword(s):

Cerebral Spinal Fluid ◽

Spinal Column ◽

Middle Cranial Fossa ◽

Paediatric Population ◽

Arachnoid Cysts ◽

Arachnoid Membrane ◽

Head Growth ◽

Asymptomatic Patients ◽

Cranial Fossa ◽

Endoscopic Fenestration

First described in 1831, arachnoid cysts are cerebral spinal fluid-filled spaces lined with arachnoid membrane. They account for 1% of all intracranial space occupying lesions and can also be found rarely in the spinal column. Most intracranial arachnoid cysts are found in the middle cranial fossa with a male predilection and a slight preponderance for the left side. With the availability of modern imaging, many more arachnoid cysts are being picked up incidentally in asymptomatic patients. However, symptomatic arachnoid cysts are predominantly found in the paediatric population with patients typically presenting with headaches, rapid head growth, developmental delay, and seizures. Treatment of patients with asymptomatic arachnoid cysts has typically been conservative management with surgery only considered in patients with symptoms. Surgical management remains controversial and includes open techniques, endoscopic fenestration of cyst, or shunting procedures.

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