Surgical management of intracranial arachnoid cysts in pediatric patients: radiological and clinical outcome

2021 ◽  
pp. 1-11
Author(s):  
Matthias Schulz ◽  
Yasin Oezkan ◽  
Andreas Schaumann ◽  
Miriam Sieg ◽  
Anna Tietze ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Mass Effect ◽  
Reoperation Rate ◽  
Arachnoid Cysts ◽  
Cyst Volume ◽  
Intracranial Cysts ◽  
Intracranial Lesions

OBJECTIVE Congenital intracranial cysts account for a significant portion of intracranial lesions in the pediatric population. The efficiency of surgical treatment in a pediatric cohort with intracranial arachnoid cysts (ACs) at different locations regarding clinical symptoms and mass effect was evaluated. METHODS A retrospective study of all children who underwent surgical treatment of an intracranial AC during an 11-year period (2007–2018) was performed. Demographics, clinical symptoms, and radiological cyst size pre- and postoperatively, as well as the reoperation rate and possible treatment complications, were analyzed. RESULTS A total of 116 intracranial cysts at 8 different anatomical locations were surgically treated in 113 children (median age 5 years and 10 months) predominantly by endoscopic technique (84%). The complication rate was 3%, and the reoperation rate was 16%. Preoperative cyst enlargement was significantly more common in infants (p < 0.0001), as was the need for reoperation (p = 0.023). After a median radiological follow-up of 26 months, > 50% reduction of cyst volume was seen in 53 cysts (46%), and 47 cysts (40%) showed a 10%–50% reduction. Acute clinical symptoms improved: nausea and vomiting, accelerated head growth, and headaches improved at 100%, 92% and 89%, respectively. However, chronic symptoms responded less favorably after a median clinical follow-up of 26 months. CONCLUSIONS The strategy of predominantly endoscopic treatment with navigation planning is efficient to alleviate clinical symptoms and to significantly reduce the mass effect of pediatric intracranial cysts at different anatomical locations. The subgroup of infants requires close pre- and postoperative monitoring.

scholarly journals Surgical management of cerebellopontine angle arachnoid cysts associated with hearing deficit in pediatric patients

2018 ◽  
Vol 21 (2) ◽  
pp. 119-123
Author(s):  
Mario Giordano ◽  
Massimo Gallieni ◽  
Amir Samii ◽  
Concezio Di Rocco ◽  
Madjid Samii
Keyword(s):  
Hearing Loss ◽  
Surgical Treatment ◽  
Cerebellopontine Angle ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Complete Recovery ◽  
The Other ◽  
Arachnoid Cysts ◽  
Recent Onset

OBJECTIVEFew cases of cerebellopontine angle (CPA) arachnoid cysts in pediatric patients have been described in the literature, and in only 2 of these cases were the patients described as suffering from hearing deficit. In this article, the authors report on 3 pediatric patients with CPA arachnoid cysts (2 with hearing loss and 1 with recurrent headaches) who underwent neurosurgical treatment at the authors’ institution.METHODSFour pediatric patients were diagnosed with CPA arachnoid cysts at the International Neuroscience Institute during the period from October 2004 through August 2012, and 3 of these patients underwent surgical treatment. The authors describe the patients’ clinical symptoms, the surgical approach, and the results on long-term follow-up.RESULTSOne patient (age 14 years) who presented with headache (without hearing deficit) became asymptomatic after surgical treatment. The other 2 patients who underwent surgical treatment both had hearing loss. One of these children (age 9 years) had recent-onset hypacusia and experienced complete recovery immediately after the surgery. The other (age 6 years) had a longer history (2 years) of progressive hearing loss and showed an interruption of the deficit progression and only mild improvement at the follow-up visit.CONCLUSIONSCPA arachnoid cysts are uncommon in pediatric patients. The indication and timing of the surgical treatment are fundamental, especially when a hearing deficit is present.

scholarly journals Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu Liu ◽  
Chunjie Liu ◽  
Dongmei Guo ◽  
Ning Wang ◽  
Ying Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Closed Reduction ◽  
Pediatric Population ◽  
Normal Weight ◽  
Medical Community ◽  
Overweight Children ◽  
Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

scholarly journals Laser interstitial thermal therapy for subependymal giant cell astrocytoma: technical case report

2016 ◽  
Vol 41 (4) ◽  
pp. E9 ◽  
Author(s):  
David Y. A. Dadey ◽  
Ashwin A. Kamath ◽  
Eric C. Leuthardt ◽  
Matthew D. Smyth
Keyword(s):  
Giant Cell ◽  
Pediatric Population ◽  
Thermal Therapy ◽  
Subependymal Giant Cell Astrocytoma ◽  
Complication Rates ◽  
Open Resection ◽  
Laser Interstitial Thermal Therapy ◽  
Intracranial Lesions ◽  
Giant Cell Astrocytoma

Subependymal giant cell astrocytoma (SEGA) is a rare tumor occurring almost exclusively in patients with tuberous sclerosis complex. Although open resection remains the standard therapy, complication rates remain high. To minimize morbidity, less invasive approaches, such as endoscope-assisted resection, radiosurgery, and chemotherapy with mTOR pathway inhibitors, are also used to treat these lesions. Laser interstitial thermal therapy (LITT) is a relatively new modality that is increasingly used to treat a variety of intracranial lesions. In this report, the authors describe two pediatric cases of SEGA that were treated with LITT. In both patients the lesion responded well to this treatment modality, with tumor shrinkage observed on follow-up MRI. These cases highlight the potential of LITT to serve as a viable minimally invasive therapeutic approach to the management of SEGAs in the pediatric population.

scholarly journals Mid-term Outcome Of Surgical Treatment In Pediatric Patients With Ebstein's Anomaly: A Single-center Cohort Study.

2020 ◽  
Author(s):  
Jia-chen Li ◽  
Xian-chao Jiang ◽  
Si-meng Zhang ◽  
Jin-yang Liu ◽  
Ya-juan Zhang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Reoperation Rate ◽  
Term Effect ◽  
Ebstein’S Anomaly ◽  
Biventricular Repair ◽  
Ebstein's Anomaly ◽  
Long Term Follow Up ◽  
Surgical Treatments

Abstract Background: Ebstein’s anomaly is a malformation of the tricuspid valve and myopathy of the right ventricle. Surgery is now the main treatment for the defect. To summarize our surgical results and experience based on patients with Ebstein’s anomaly who were under 7 years of age and treated with different surgical treatments.Materials and Methods: From January 2010 to December 2019, 80 patients under 7 years old who were diagnosed of Ebstein’s anomaly and underwent different surgical treatments were consecutively enrolled and followed up in detail. Results: The median age of the 80 patients at the time of surgery was 3.63 years. Sixty-four (80.00%) patients underwent biventricular repair while 13 (16.25%) underwent 1.5-ventricle repair. With the median follow-up 27.50 months, the long-term survival of the total cohort, 1.5-ventricular repair and biventricular repair was 82.35%, 91.67% and 100%, respectively. The long-term freedom from reoperation rate was 97.50%, 92.31% and 98.44%, respectively. Mild, moderate and severe TR before surgery occurred in 6 (7.50%), 18 (22.50%) and 56 (70.00%), respectively. The early outcomes of 78 patients were 65 (83.33%), 11 (14.11%) and 2 (2.56%); the mid-term outcomes of 72 patients were 49 (68.06%), 19 (26.38%) and 4 (5.56%). Both early and long-term valve regurgitation were significantly decreased (p< 0.001) compared with preoperative condition. No more severe regurgitation occurred (p=0.404), though some early mild regurgitation became acceptable moderate regurgitation during long-term follow-up (p=0.036). Compared with Carpentier procedure, cone procedure had better long-term effect, while the effect of whole-valve technique needed more operation and long-term follow-up.Conclusion: The reoperation rate and mid-term mortality of surgical treatment for Ebstein’s anomaly were both low, tricuspid regurgitation was significantly improved during mid-term follow up. Cone procedure had the best mid-term effect among anatomic repair.

Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspects

2011 ◽  
Vol 115 (5) ◽  
pp. 885-893 ◽  
Author(s):  
Rick van de Langenberg ◽  
Patrick E. J. Hanssens ◽  
Jeroen B. Verheul ◽  
Jacobus J. van Overbeeke ◽  
Patty J. Nelemans ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Clinical Symptoms ◽  
Growth Control ◽  
Mass Effect ◽  
Gamma Knife Surgery ◽  
Clinical Aspects ◽  
Volumetric Growth ◽  
Trigeminal Neuropathy ◽  
Clinical Control

Object In large vestibular schwannomas (VSs), microsurgery is the main treatment option. A wait-and-scan policy or radiosurgery are generally not recommended given concerns of further lesion growth or increased mass effect due to transient swelling. Note, however, that some patients do not present with symptomatic mass effect or may still have serviceable hearing. Moreover, others may be old, suffer from severe comorbidity, or refuse any surgery. In this study the authors report the results in patients with large, growing VSs primarily treated with Gamma Knife surgery (GKS), with special attention to volumetric growth, control rate, and symptoms. Methods The authors retrospectively analyzed 33 consecutive patients who underwent GKS for large, growing VSs, which were defined as > 6 cm3 and at least indenting the brainstem. Patients with neurofibromatosis Type 2 were excluded from analysis, as were patients who had undergone previous treatment. Volume measurements were performed on contrast-enhanced T1-weighted MR images at the time of GKS and during follow-up. Medical charts were analyzed for clinical symptoms. Results Radiological growth control was achieved in 88% of cases, clinical control (that is, no need for further treatment) in 79% of cases. The median follow-up was 30 months, and the mean VS volume was 8.8 cm3 (range 6.1–17.7 cm3). No major complications occurred, although ventriculoperitoneal shunts were placed in 2 patients. The preservation of serviceable hearing and facial and trigeminal nerve function was achieved in 58%, 91%, and 86% of patients, respectively, with any facial and trigeminal neuropathy being transient. In 92% of the patients presenting with trigeminal hypesthesia before GKS, the condition resolved during follow-up. No patient- or VS-related feature was correlated with growth. Conclusions Primary GKS for large VSs leads to acceptable radiological growth rates and clinical control rates, with the chance of hearing preservation. Although a higher incidence of clinical control failure and postradiosurgical morbidity is noted, as compared with that for smaller VSs, primary radiosurgery is suitable for a selected group of patients. The absence of symptomatology due to mass effect on the brainstem or cerebellum is essential, as are close clinical and radiological follow-ups, because there is little reserve for growth or swelling.

scholarly journals Clinical symptoms and sonographic follow-up after surgical treatment of nonparasitic liver cysts

BMC Surgery ◽  
2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Hubert Scheuerlein ◽  
Falk Rauchfuss ◽  
Julia Franke ◽  
Karin Jandt ◽  
Yves Dittmar ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Liver Cysts

scholarly journals Results of surgical treatment of children with PFAPA syndrome

2019 ◽  
pp. 244-251
Author(s):  
A. S. Yunusov ◽  
T. I. Garashchenko ◽  
P. I. Belavina ◽  
A. G. Ryazanskaya ◽  
E. V. Molodtsova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Pediatric Population ◽  
Quality Of Life Indicators ◽  
Before And After ◽  
Pfapa Syndrome ◽  
Primary School Age

Rationale. Currently, the literature describes about 374 cases of Marshall syndrome. According to some authors, the prevalence of Marshall syndrome is 2.3 per 10,000 children, in general, the epidemiology of PFAPA syndrome in the pediatric population is unknown.Purpose. The aim of our study is to justify surgical treatment in children with Marshall syndrome. Objectives. The objectives of this study are to give a comparative assessment of the effectiveness of tonsillectomy and adenotonzyllectomy for this syndrome and to evaluate the quality of life indicators before and after surgical treatment.Materials and methods. The study included 26 patients with Marshall syndrome, of which 18 patients underwent adenotonzyllectomy and 8 patients underwent bilateral tonsillectomy. A clinical case of a typical manifestation of Marshall syndrome is also described, and follow-up results of the effectiveness of surgical treatment for Marshall syndrome are presented. In the course of the work, an adapted questionnaire was developed to assess the quality of life of parents of children with Marshall syndrome.Results. The result of our work is the fact that in relation to the relief of PFAPA-syndrome, children of preschool and primary school age have more effective adenotonsillectomy (88.2%), while tonsillectomy was effective only in 55.6% of patients.Conclusion. A multidisciplinary approach is required to address the diagnosis and treatment of Marshall syndrome.

Surgical treatment and outcome of posterior fossa arachnoid cysts in infants

2021 ◽  
pp. 1-9
Author(s):  
Jehuda Soleman ◽  
Danil A. Kozyrev ◽  
Shlomi Constantini ◽  
Jonathan Roth
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Revision Surgery ◽  
Arachnoid Cysts ◽  
Study Patient ◽  
Younger Age ◽  
Additional Surgery ◽  
Age At Surgery ◽  
Permanent Morbidity

OBJECTIVE The aim of this cohort study was to describe and analyze the surgical treatment and outcome of posterior fossa arachnoid cysts (PFACs) in infants. METHODS Patients presenting with a PFAC at infancy or prenatally, between the years 2000 and 2019, and who were surgically treated before the age of 2 years, were included in this study. Patient data were retrospectively collected including baseline characteristics and surgical variables. Factors related to revision surgery were analyzed through uni- and multivariate analysis. RESULTS Thirty-five patients, of whom 54.3% were male, were included. The cyst was diagnosed prenatally in 23 patients (65.7%). Surgery was typically recommended after a mean cyst follow-up of 3.4 ± 3.9 months, with a mean age at surgery of 6.1 ± 5.1 months. In 54.3% of patients (n = 19), surgery was performed before the age of 6 months. The PFAC was treated purely neuroendoscopically in 57.1% of patients (n = 20), while 28.6% of patients underwent open cyst procedures (n = 10), 5.7% (n = 2) were treated with a shunt, and 8.6% (n = 3) underwent a combined procedure. Additional surgery was required in 31.4% of patients (n = 11; mean 2.36 ± 2.11 surgeries per patient). At the last follow-up (61.40 ± 55.33 months), no mortality or permanent morbidity was seen; radiological improvement was apparent in 83.9% of the patients. Those patients treated before the age of 6 months (p = 0.09) and who presented before surgery with a stable cyst size that was maintained throughout preoperative monitoring (p = 0.08) showed a trend toward higher revision rates after surgical treatment. CONCLUSIONS PFACs in infancy may require surgical treatment before the age of 6 months. Navigated endoscopy was a valid surgical option. Overall mortality or permanent morbidity was rare. Additional surgery was required in up to 30% of the patients; younger age and a preoperatively stable cyst might be risk factors for revision surgery.

scholarly journals Intraparenchymal supratentorial arachnoid cyst: a case report

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Domagoj Dlaka ◽  
Marina Raguž ◽  
Danko Muller ◽  
Dominik Romić ◽  
Fadi Almahariq ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Subarachnoid Space ◽  
Clinical Symptoms ◽  
Arachnoid Cysts ◽  
Anatomical Location ◽  
Left Frontal Lobe ◽  
Case Presentation ◽  
Intracranial Lesions ◽  
Anatomic Distribution ◽  
Surgical Treatments

Abstract Background Intracranial arachnoid cysts are collections of cerebrospinal fluid within the arachnoid membrane and subarachnoid space of the cisterns and major cerebral fissures that account for about 1% of all intracranial lesions. Expansion of the cyst and compression on surrounding structures may became symptomatic, which reflects its size and anatomic distribution. Case presentation Here, we present a very rare case of patient with supratentorial intraparenchymal arachnoid cyst placed in the left frontal lobe without any communication with the subarachnoid space and ventricle and presented with clinical symptoms. The patient underwent fenestration of the lesion and was clinically improved. Conclusions Although the etiology and the enlargement mechanism of arachnoid cysts remain unclear, both conservative and surgical treatments are optional. According to size, anatomical location, neuroimaging, and clinical symptoms, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.

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

2007 ◽  
Vol 86 (6) ◽  
pp. 338-341 ◽  
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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