scholarly journals Exploring predictors of surgery and comparing operative treatment approaches for pediatric intracranial arachnoid cysts: a case series of 83 patients

2015 ◽  
Vol 16 (3) ◽  
pp. 275-282 ◽  
Author(s):  
Mohsin Ali ◽  
Michael Bennardo ◽  
Saleh A. Almenawer ◽  
Nirmeen Zagzoog ◽  
Alston A. Smith ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Surgical Outcomes ◽  
Predictive Value ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Arachnoid Cysts ◽  
Surgical Approaches ◽  
Cyst Size ◽  
Intracranial Arachnoid Cyst ◽  
Flow Pathway

OBJECT Although intracranial arachnoid cysts are a common incidental finding on pediatric brain imaging, only a subset of patients require surgery for them. For the minority who undergo surgery, the comparative effectiveness of various surgical approaches is debated. The authors explored predictors of surgery and compared operative techniques for pediatric patients with an intracranial arachnoid cyst seen at a tertiary care center. METHODS The authors reviewed records of pediatric patients with an intracranial arachnoid cyst. For each patient, data on baseline characteristics, the method of intervention, and surgical outcomes for the initial surgery were extracted, and cyst size at diagnosis was calculated (anteroposterior × craniocaudal × mediolateral). Baseline variables were analyzed as predictors of surgery by using logistic regression modeling, excluding patients whose surgery was not related to cyst size (i.e., those with obstructive hydrocephalus secondary to the cyst compressing a narrow CSF flow pathway or cyst rupture/hemorrhage). Data collected regarding surgical outcomes were analyzed descriptively. RESULTS Among 83 pediatric patients with an intracranial arachnoid cyst seen over a 25-year period (1989–2013), 27 (33%) underwent surgery; all had at least 1 cyst-attributed symptom/finding. In the multivariate model, age at presentation and cyst size at diagnosis were independent predictors of surgery. Cyst size had greater predictive value; specifically, the area under the curve for the receiver-operating-characteristic curve was 0.89 (95% CI 0.82–0.97), with an ideal cutoff point of ≥ 68 cm3. This cutoff point had 100% sensitivity (95% CI 79%–100%), 75% specificity (95% CI 61%–85%), a 53% positive predictive value (95% CI 36%–70%), and a 100% negative predictive value (95% CI 91%–100%); the positive likelihood ratio was 4.0 (95% CI 2.5–6.3), and the negative likelihood ratio was 0 (95% CI 0–0.3). Although the multivariate model excluded 7 patients who underwent surgery (based on prespecified criteria), excluding these 7 cases did not change the overall findings, as shown in a sensitivity analysis that included all the cases. Descriptive results regarding surgical outcomes did not indicate any salient differences among the surgical techniques (endoscopic fenestration, cystoperitoneal shunting, or craniotomy-based procedures) in terms of symptom resolution within 6 months, need for reoperation to date, cyst-size change from before the operation, morbidity, or mortality. CONCLUSIONS The results of these exploratory analyses suggest that pediatric patients with an intracranial arachnoid cyst are more likely to undergo surgery if the cyst is large, compresses a narrow CSF flow pathway to cause hydrocephalus, or has ruptured/hemorrhaged. There were no salient differences among the 3 surgical techniques for several clinically important outcomes. A prospective multicenter study is required to enable more robust analyses, which could ultimately provide a decision-making framework for surgical indications and clarify any differences in the comparative effectiveness of surgical approaches to treating pediatric intracranial arachnoid cysts.

Microsurgical Keyhole Approach for Middle Fossa Arachnoid Cyst Fenestration

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1138-1145 ◽  
Author(s):  
Michael L. Levy ◽  
Michael Wang ◽  
Henry E. Aryan ◽  
Kevin Yoo ◽  
Hal Meltzer
Keyword(s):  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Treatment Modalities ◽  
Middle Fossa ◽  
Imaging Studies ◽  
Cyst Size ◽  
Serial Imaging ◽  
Keyhole Approach ◽  
Cyst Fenestration

Abstract OBJECTIVE The optimal surgical treatment for symptomatic temporal arachnoid cysts is controversial. Therapeutic options include cyst shunting, endoscopic fenestration, and craniotomy for fenestration. We reviewed the results for patients who were treated primarily with craniotomy and fenestration at our institution, to provide a baseline for comparisons of the efficacies of other treatment modalities. METHODS A retrospective review of data for 50 children who underwent keyhole craniotomy for fenestration of temporal arachnoid cysts between 1994 and 2001 was performed after institutional review board approval. During that period, the first-line treatment for all symptomatic middle fossa arachnoid cysts was microcraniotomy for fenestration. Microsurgical dissection to create communications between the cyst cavity and basal cisterns was the goal. All patient records were reviewed and numerous variables related to presentation, cyst size and classification, treatment, cyst resolution, symptom resolution, follow-up periods, and cyst outcomes were recorded. RESULTS Fifty temporal arachnoid cysts in 50 treated patients were identified. The average age at the time of surgery was 68 ± 57.2 months. The follow-up periods averaged 36 months. There were 34 male and 16 female patients in the series. Twenty-six cysts were on the left side. Indications for surgery included intractable headaches (45%), increasing cyst size (21%), seizures (25%), and hemiparesis (8%). The symptoms most likely to improve were hemiparesis (100%) and abducens nerve palsies. Headaches (67%) and seizure disorders (50%) were less likely to improve. Nine patients exhibited progressive increases in cyst size in serial imaging studies. Those patients were monitored for a mean of 40 ± 23 months before intervention. In the entire series, 82% of patients demonstrated decreases in cyst size in serial imaging studies. Of those patients, 18% demonstrated complete cyst effacement. Overall, 83% of patients with Grade II cysts and 75% of patients with Grade III cysts exhibited evidence of decreases in cyst size in long-term monitoring. Two patients required shunting after craniotomy (4%). Hospital stays averaged 3.4 days. Total surgical times averaged 115 minutes. No significant blood loss occurred (5–50 ml). Complications included spontaneously resolving pseudomeningocele (10%), transient Cranial Nerve III palsy (6%), cerebrospinal fluid leak (6%), subdural hematoma (4%), and wound infection (2%). CONCLUSION A microsurgical keyhole approach to arachnoid cyst fenestration is a safe effective method for treating middle fossa cysts. This procedure can be performed with minimal morbidity via a minicraniotomy. Compared with an endoscopic approach, better control of hemostasis can be obtained, because of the ability to use bipolar forceps and other standard instruments. The operative time and length of hospital stay were not excessively increased.

Thoracic arachnoid cyst resection

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video4 ◽  
Author(s):  
Harel Deutsch
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Surgical Techniques ◽  
Mass Effect ◽  
Cord Compression ◽  
Arachnoid Cysts ◽  
Mri Scan ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Thin Walled

Arachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts may exert mass effect on the thoracic spinal cord and lead to pain and myelopathy symptoms. Arachnoid cysts may be difficult to visualize on an MRI scan because the thin walled arachnoid may not be visible. Focal displacement of the thoracic spinal cord and effacement of the spinal cord with apparent widening of the cerebrospinal fluid space is seen. This video demonstrates surgical techniques to remove a dorsal arachnoid cyst causing spinal cord compression. The surgery involves a thoracic laminectomy. The dura is opened sharply with care taken not to open the arachnoid so that the cyst can be well visualized. The thickened arachnoid walls of the cyst are removed to alleviate the compression caused by the arachnoid cyst.The video can be found here: http://youtu.be/pgUrl9xvsD0.

scholarly journals Hemorrhagic infarction following open fenestration of a large intracranial arachnoid cyst in a pediatric patient

2015 ◽  
Vol 15 (2) ◽  
pp. 203-206 ◽  
Author(s):  
Tyler Auschwitz ◽  
Michael DeCuypere ◽  
Nickalus Khan ◽  
Stephanie Einhaus
Keyword(s):  
Arachnoid Cyst ◽  
Treatment Options ◽  
Rare Condition ◽  
Arachnoid Cysts ◽  
Intraparenchymal Hemorrhage ◽  
Hemorrhagic Infarction ◽  
Csf Shunting ◽  
Intracranial Arachnoid Cyst ◽  
Variable Presentation ◽  
Endoscopic Fenestration

Intracranial arachnoid cysts are a rare condition thought to be congenital in nature. Treatment of intracranial arachnoid cysts remains controversial based on their variable presentation. Treatment options include CSF shunting, endoscopic fenestration, or craniotomy and open fenestration for larger cysts. The complications of these procedures can include hydrocephalus, subdural hematomas, hygromas, and—more rarely—intraparenchymal hemorrhage. The authors found very few reports of hemorrhagic infarction as a complication of arachnoid cyst fenestration in the literature. The authors report a case of an 18-year-old female patient who suffered an ipsilateral hemorrhagic infarction after craniotomy for open fenestration of an arachnoid cyst.

Individual surgical treatment of intracranial arachnoid cyst in pediatric patients

2013 ◽  
Vol 61 (4) ◽  
pp. 400 ◽  
Author(s):  
Yunbiao Xiong ◽  
Chao You ◽  
Guoqiang Han ◽  
Chuangxi Liu ◽  
Chao Wang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Intracranial Arachnoid Cyst

scholarly journals Giant Intracranial Arachnoid Cyst Mimicking Benign Paroxysmal Vertigo of Childhood: Case Report with Review of Literature

2014 ◽  
Vol 6 (4) ◽  
pp. 6-9
Author(s):  
Amit Kumar Tyagi ◽  
Gaurav Ashish ◽  
Anjali Lepcha ◽  
Achamma Balraj
Keyword(s):  
Case Report ◽  
Arachnoid Cyst ◽  
Signs And Symptoms ◽  
Arachnoid Cysts ◽  
Review Of Literature ◽  
Intracranial Arachnoid Cyst ◽  
Peripheral Vertigo

ABSTRACT Arachnoid cysts constitute 1% of all intracranial space-occupying lesions. These typically produce vague and nonspecific symptoms. However, a subset of these lesions can produce constellation of signs and symptoms indistinguishable from those causing peripheral vertigo. We discuss the presentation of a giant arachnoid cyst which presented with dizziness and mimicked benign paroxysmal vertigo of childhood (BPVC).

scholarly journals Subdural haemorrhage secondary to arachnoid cyst rupture from scuba diving

2017 ◽  
Vol 4 (4) ◽  
pp. 1438
Author(s):  
Emily A. Richardson ◽  
Peter Gan
Keyword(s):  
Arachnoid Cyst ◽  
Adult Male ◽  
Healthy Adult ◽  
Scuba Diving ◽  
Arachnoid Cysts ◽  
Subdural Haemorrhage ◽  
First Case ◽  
Healthy Adult Male ◽  
Intracranial Arachnoid Cyst ◽  
Cyst Rupture

We describe a case of intracranial arachnoid cyst rupture leading to ipsilateral subacute subdural haemorrhage secondary to scuba diving in a previously healthy adult male. Our patient required urgent trephination of the cranium to evacuate the subdural haemorrhage and recovered well post operatively. To our knowledge this is the first case reported in the literature of arachnoid cyst rupture with concomitant subdural haemorrhage from scuba diving.  This case may have implications for information provided to patients with arachnoid cysts.

scholarly journals Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

2007 ◽  
Vol 22 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Gabriel Zada ◽  
Mark D. Krieger ◽  
Sean A. McNatt ◽  
Ira Bowen ◽  
J. Gordon McComb
Keyword(s):  
Los Angeles ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Clinical Signs ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Arachnoid Cysts ◽  
P Value ◽  
Clinical Signs And Symptoms

Object Arachnoid cysts can cause a variety of clinical signs and symptoms in infants. The authors sought to determine whether the clinical presentation of pediatric patients younger than 2 years old and harboring arachnoid cysts influenced the type of intervention that would be required. Methods A retrospective chart review was conducted for all patients younger than 2 years of age who had undergone craniotomy for fenestration of an arachnoid cyst at the Childrens Hospital Los Angeles between 1995 and 2006. Forty-two patients were included in the study. The mean age was 10.4 months. The median follow-up time was 33 months. Clinical presentations were as follows: macrocephaly without ventriculomegaly (21 patients, 50%), hydrocephalus (six patients, 14%), and other symptoms (15 patients, 36%). After fenestration of the arachnoid cyst, 12 of 21 patients (57%) presenting with nonspecific macrocephaly required placement of a cystoperitoneal or ventriculoperitoneal shunt, compared with 1 of 15 patients (7%) presenting with other symptoms (p value = 0.0039). Five of six patients with hydrocephalus (83%) were shunt dependent following fenestration. Overall, 18 of 42 patients (43%) were shunt dependent after fenestration. Ten of these patients (55%) required revisions during the follow-up period. Conclusions Patients younger than 2 years of age and harboring an arachnoid cyst commonly present with macrocephaly. These patients are more likely to require shunts than are those presenting with other findings, such as seizu

Intracranial arachnoid cysts in children

1986 ◽  
Vol 64 (6) ◽  
pp. 835-842 ◽  
Author(s):  
Griffith Rutherford Harsh ◽  
Michael S. B. Edwards ◽  
Charles B. Wilson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Arachnoid Cysts ◽  
Anatomical Location ◽  
Resonance Imaging ◽  
Cyst Size ◽  
Radiographic Findings ◽  
Content Type ◽  
Fine Print

✓ 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.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

2018 ◽  
Vol 5 (1) ◽  
pp. 13-23
Author(s):  
Nikolai S. Grachev ◽  
Elena V. Feoktistova ◽  
Igor N. Vorozhtsov ◽  
Natalia V. Babaskina ◽  
Ekaterina Yu. Iaremenko ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Thyroid Neoplasms ◽  
Diagnostic Methods ◽  
Diagnostic Approach ◽  
First Line ◽  
Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

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