Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children |
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Authors: | J -K Kang K S Lee I W Lee S S Jeun B C Son C K Jung Y S Park S W Lee |
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Institution: | (1) Department of Neurosurgery, Kangnam St. Mary’s Hospital, Catholic University Medical College, 505 Banpo-dong Seocho-ku, Seoul, 137-040, Korea, e-mail: jkkmd@cmc.cuk.ac.kr Tel.: +82-2-5901342/2800 Fax: +82-2-5944248, KR |
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Abstract: | 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. Among a total of 66 intracranial arachnoid cysts operated on in the authors’ department from 1985 to 1997,
44 cases (67%) were located in the middle cranial fossa. A higher incidence in the first decade of life (53 cases) and a marked
male predominance (45 cases) were recognized. Headache, cranial deformities, symptoms of raised intracranial pressure, and
seizures constituted the most frequent features of the clinical presentation. To determine which treatment provides the greatest
benefit with the lowest incidence of complications, the records of the 44 patients with arachnoid cysts in the middle cranial
fossa were reviewed. The mean age of these patients was 4.6 years (range 0–16 years). Different types of initial surgical
procedures were performed. In 33 patients with middle cranial fossa arachnoid cysts (MCFAC) the initial surgery took the form
of craniotomy with excision of the cyst walls and fenestration into the basal cisterns. Shunting procedures were performed
in 9 patients: cysto-peritoneal shunts (CPS) were placed in 4 patients and ventriculo-peritoneal shunts (VPS), in 3 patients,
and cyst excision was performed in addition to CPS in 2 patients. Excision of the cyst membrane alone without fenestration
was performed in 2 patients. The initial treatment was successful in terms of reduced symptoms and decreased cyst size, with
no additional treatment needed for the cyst, in 79% (26/33) of patients who had undergone excision of the cyst walls and fenestration
into the basal cisterns, compared with 66% (6/9) of patients who had undergone shunting procedures. Cyst membrane excision
was not successful in any of the patients who underwent this procedure alone. No significant difference in morbidity was noted
between these different treatment options. On follow-up CT scan and MRI, cysts of types I and II (Galassi classification)
exhibited a steady tendency to reduction or obliteration. These results confirm that radical excision of the outer and inner
membranes of the cyst wall with fenestration into the basal cistern is a safe and effective shunt-independent procedure for
MCFAC, especially for those of types I and II.
Received: 28 May 1999 Revised: 10 August 1999 |
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Keywords: | Arachnoid cyst Middle cranial fossa Fenestration Shunt-independent |
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