Top

Child's Nervous System

Published in:

01-05-2008 | Controversy in Neurosurgery

Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management

Authors: Gianpiero Tamburrini, Mateus Del Fabbro, Concezio Di Rocco

Published in: Child's Nervous System | Issue 5/2008

Abstract

Background

The management of Sylvian arachnoid cysts in children is still a matter of debate. Diagnosis is often incidental, and symptoms are frequently aspecific in symptomatic cases. Suggested diagnostic investigation results have been often unclear. Surgical treatment is also controversial, pure, and assisted endoscopic cyst marsupialization having entered in the traditional debate between craniotomic and shunting approach

Purpose

The objective of the present study was to survey if (and, eventually, which) agreement points do actually exist between internationally recognized pediatric neurosurgery centers in the management of children with a controversial type of Sylvian arachnoid cyst (Type II cyst).

Methods

Contributors were asked to answer to a six-separate-part multiple choice questionnaire related to the case of a 2.7-year-old boy with a Type II left Sylvian arachnoid cyst presented in different clinical situations. If surgery was indicated, it was asked which surgical procedure the authors would have suggested as first option.

Results and conclusions

The option of the mere clinical observation was chosen by the majority of surgeons in case of asymptomatic clinical discovery. On the other hand, a constantly high percentage of participants suggested direct surgical treatment based on clinical manifestations or as a preventive measure justified by the risk of spontaneous or traumatic intracranial bleeding. The only diagnostic investigation result which significantly influenced the surgical indication was a localizing electroencephalography, if the child presented with seizures. The result is that in most cases the surgical indication was based on aspecific clinical manifestations and laboratory data. Craniotomy and arachnoid cyst marsupialization represented the preferred surgical option (66.6%), 28.8% of the participants suggesting pure or assisted endoscopic cyst marsupialization as primary surgical procedure. Cyst shunting was suggested by only three centers.

Aoki N, Sakai T, Umezawa Y (1990) Slit ventricle syndrome after cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst. Childs Nerv Syst 6(1):41–43PubMedCrossRef

Arai H, Sato K, Wachi A, Okuda O, Takeda N (1996) Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery 39(6):1108–1113PubMedCrossRef

Arroyo S, Santamaria J (1997) What is the relationship between arachnoid cysts and seizure foci. Epilepsia 38(10):1098–1102PubMedCrossRef

Beldzinska MM, Ostrowska ED (2002) Presentation of intracranial arachnoid cysts in children: correlation between localization and clinical symptoma. Med Sci Monit 8(6):462–465

Beltramello A, Mazza C (1985) Spontaneous disappearance of a large middle fossa arachnoid cyst. Surg Neurol 24(2):181–183PubMedCrossRef

Choi JU, Kim DS, Huh R (1999) Endoscopic approach to arachnoid cyst. Childs Nerv Syst 15(6–7):285–291PubMedCrossRef

Cinalli G, Spennato P, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, Cianciulli E, Maggi G (2007) Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23(6):633–644PubMedCrossRef

Ciricillo SF, Cogen PH Harsh GR, Edwards MS (1991) Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting. J Neurosurg 74(2):230–235PubMed

De Volder AG, Michel C, Thauvoy C, Willems G, Ferriere G (1994) Brain glucose utilization in acquired childhood aphasia associated with a sylvian arachnoid cyst: recovery after shunting as demonstrated by PET. J Neurol Neurosurg Psychiatry 57(3):296–300PubMed

10.

Di Rocco C (1996) Arachnoid cysts. In: Youmans JR (ed) Neurological surgery. Saunders, Philadelphia, pp 967–994

11.

Di Rocco C, Tamburrini G, Caldarelli M, Velardi F, Santini P (2003) Prolonged ICP monitorino in sylvian arachnoid cysts. Surg Neurol 60:211–218PubMedCrossRef

12.

Eguchi T, Taoka T, Nikaido Y, Shiomi K, Fujimoto T, Otzuka H, Takeuchi H (1996) Cine-Magnetic Resonance Imaging evaluation of communication between middle cranial fossa arachnoid cysts and cisterns. Neurol Med Chir 36:353–357CrossRef

13.

Elhammady MS, Bhatia S, Ragheb J (2007) Endoscopic fenestration of middle fossa arachnoid cysts: a technical description and case series. Pediatr Neurosurg 43(3):209–215PubMedCrossRef

14.

Eskandary H, Sabba M, Khajehpour F, Eskandari M (2005) Incidental findings in brain computed tomography scans of 3,000 head trauma patients. Surg neurol 63(6):550–553PubMedCrossRef

15.

Fewel ME, Levy ML, McComb JG (1996) Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 25(4):165–173PubMedCrossRef

16.

Germanò A, Caruso G, Caffo M, Baldari S, Calisto A, Meli F, Tomasello F (2003) The treatment of large supratentorial arachnoid cysts in infants with cyst-peritoneal shunting and Hakim programmable valve. Childs Nerv Syst 19(3):166–173PubMed

17.

Godano U, Mascari C, Consales A, Calbucci F (2004) Endoscope-controlled microneurosurgery for the treatment of intracranial fluid cysts. Childs nerv Syst 20(11, 12):839–841PubMedCrossRef

18.

Gosalakkal JA (2002) Intracranial arachnoid cysts in children: a review of pathogenesis, clinical features and management. Ped Neurol 26(2):93–98CrossRef

19.

Hamid N, Sgouros S (2005) The use off an adjustable valve to treat over-drainage of a cyst-peritoneal shunt in a child with a large sylvian fissure arachnoid cyst. Childs Nerv Syst 21(11):991–994PubMedCrossRef

20.

Helland CA, Wester K (2006) Arachnoid cysts in adults: long-term follow-up of patients treated with internal shunts to the subdural compartment. Surg Neurol 66(1):56–61PubMedCrossRef

21.

Helland CA, Wester K (2007) Intracystic pressure in patients with temporal arachnoid cysts: a prospective study of preoperative complaints and postoperative outcome. J Neurol Neurosurg Psychiatry 78(6):620–623PubMedCrossRef

22.

Hoffman KT, Hosten N, Meyer BU, Roricht S, Sprung X, Oellinger J, Guilbert M, Felix R (2000) CSF flow studies of intracranial cysts and cyst-like lesions achieved using reversed fast imaging with steady-state precession MR sequences. AJNR 21:493–502

23.

Hopf NJ, Pernezski A (1998) Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43(6):1330–1336PubMedCrossRef

24.

Huang Q, Wang D, Guo Y, Zhou X, Wang X, Li X (2007) The diagnosis and neuroendoscopic treatment of noncommunicating intracranial arachnoid cysts. Surg Neurol 68(2):149–154PubMedCrossRef

25.

Hund-Georgiadis M, von Cramon Y, Kruggel F, Preul C (2002) Do quiescient arachnoid cysts alter CNS functional organization? A fMRI and morphometric study. Neurology 52(2):1935–1939

26.

Kang JK, Lee KS, Lee IW, Jeun SS, Son BC, Jung CK, Park YS, Lee SW (2000) Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children. Childs Nerv Syst 16(2):111–116PubMedCrossRef

27.

Karabatsu K, Hayhrust H, Buxton N, O’Brien DF, Mallucci CL (2007) Endoscopic management of arachnoid cysts: an advancing technique. J Neurosurg (Pdiatrics 6) 106:455–462CrossRef

28.

Kawamura T, Morioka T, Nishio S, Fukui K, Yamasaki R, Matsuo M (2002) Temporal lobe epilepsy associated with hippocampal sclerosis and a contralateral middle fossa arachnoid cyst. Seizure 11(1):60–62PubMedCrossRef

29.

Kim DS, Choi JU, Huh R, Yun PH, Kim DI (1999) Quantitative assessment of cerebrospinal fluid hydrodynamics using phase-contrast cine-MR in hydrocephalus. Childs Nerv Syst 15:461–467PubMedCrossRef

30.

Kim SK, Cho BK, Chung YN, Kim HS, Wang KC (2002) Shunt dependency in shunted arachnoid cyst: a reason to avoid ahunting. Pediatr Neurosurg 37(4):178–185PubMedCrossRef

31.

Kobayashi E, Bonilha L, Li LM, Cendes F (2003) Temporal lobe hypogenesis associated with arachnoid cyst in patients with epilepsy. Arq Neuropsiquiatr 61(2B):327–329PubMed

32.

Koch CA, Voth D, Kraemer G, Schwarz M (1995) Arachnoid cysts: does surgery improve epileptic seizures and headaches. Neurosurg Rev 18(3):173–181PubMedCrossRef

33.

Koch CA, Moore JL, Voth D (1998) Arachnoid cysts: how do postsurgical cyst size and seizure outcome correlate. Neurosurg Rev 21(1):14–22PubMedCrossRef

34.

Kramer U, Nevo Y, Reider-Grosswasser I (1998) Neuroimaging of children with partial seizures. Seizure 7:115–118PubMed

35.

Krupp W, Dohnert J, Kellermann S, Seifert V (1999) Intradiploic arachnoid cyst with extensive deformation of craniofacial osseous structures:case report. Neurosurgery 44:868–870PubMedCrossRef

36.

Kushen MC, Frim D (2007) Placement of subdural electrode grids for seizure focus localization in patients with a large arachnoid cyst. Technical note. Neurosurg Focus 22(2):E5PubMedCrossRef

37.

Lena G, Erdincler P, Van Calenbergh F, Genitori L, Choux M (1996) Arachnoid cysts of the middle cranial fossa in children. A review of 75 cases, 47 of which have been operated in a comparative study between membranectomy wit opening of cisterns and cystoperitoneal shunt. Neurochirurgie 42(1):29–34PubMed

38.

Levy ML, Meltzer HS, Hughes S, Aryana HE, Yoo K, Amar AP (2004) Hydrocephalus in children with middle fossa arachnoid cysts. J Neurosurg (Pediatrics 2) 101:25–31

39.

Levy ML, Wang M, Aryan HE, Yoo K, Meltzer H (2005) Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 56(5):E1166

40.

Martinez-Lage JF, Valenti JA, Piqueras C, Ruiz-Espejo AM, Roman F, Nuno de la Rosa JA (2006) Functional assessment of intracranial arachnoid cysts with TC99 m-HMPAO SPECT: a preliminary report. Childs Nerv Syst 22:1091–1097PubMedCrossRef

41.

Mazurkiewicz-Beldzinska M, Dilling-Ostrowska E (2002) Presentation of intracranial arachnoid cysts in childrem: correlation between localization and clinical symptoms. Med Sci Monit 8(6):CR–462–CR-465

42.

McDonald PJ, Rutka JT (1997) Middle cranial fossa arachnoid cysts that come and go. Report of two cases and review of the literature. Pediatr Neurosurg 26(1):48–52PubMedCrossRef

43.

Millichap JG (1997) Temporal lobe arachnoid cyst-attention deficit disorder syndrome: role of the EEG in diagnosis. Neurology 48(5):1435–1439PubMed

44.

Morioka T, Nishio S, Ishibashi H, Fukui M (1998) What is the relationship between arachnoid cysts and seizure foci. Epilepsia 49(7):804–805 (Letter)CrossRef

45.

Mottolese C, Szathmari A, Di Somma L, Simon E, Ricci-Franchi AC, Cinguene C, Lak C, Vallee B (2007) Treatment of arachnoid cysts with endoscopic fenestration and shunting with programmable valve. Our experience. Childs Nerv Syst 23:1054–1055CrossRef

46.

Nowolawska E, Polis L, Kaniewska D, Mikolajczyk W, Krawczyk J, Szymanski W, Zakrewski K, Podciechowska J (2003) A comparison of neuroendoscopic techniques with other surgical procedures in the treatment of arachnoid cysts in children. Neurol Neurochir Pol 37(3):587–600

47.

Nowolawska E, Polis L, Kaniewska D, Mikolajczyk W, Krawczyk J, Szymanski W, Zakrewski K, Podciechowska J, Polis B (2006) Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods. Childs Nerv Syst 22(6):599–604CrossRef

48.

Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8(5):281–286PubMedCrossRef

49.

Ozgur BM, Aryan HE, Levy ML (2005) Microsurgical keyhole middle fossa arachnoid cyst fenestration. J Clin Neurosci 12(7):804–806PubMedCrossRef

50.

Paladino J, Rotim K, Heinrich Z (1998) Neuroendoscopic fenestration of arachnoid cysts. Minim Invasive Neurosurg 41(3):137–140PubMedCrossRef

51.

Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K (1997) Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 40(3):483–490PubMedCrossRef

52.

Pradilla G, Jallo G (2007) Arachnoid cysts: case series and review of the literature. Neurosurg Focus 22(2):E7PubMedCrossRef

53.

Pulido-Rivas P, Villarejo-Ortega FJ, Cordobès-Tapia F, Pascual Martìn-Gamero A, Pèrez-Diaz C (2006) Surgical treatment of arachnoid cysts in children. Rev Neurol 42(6):383–384

54.

Raeder MB, Helland CA, Hugdhal K, Wester K (2005) Arachnoid cysts cause cognitive deficits that improve after surgery. Neurology 64(1):60–62

55.

Raffel C, McComb JG (1988) To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients. Neurosurgery 23(3):338–342PubMedCrossRef

56.

Rao G, Anderson RC, Feldstein NA, Brockmeyer DL (2005) Expansion of arachnoid cysts in children: report of two cases and review of the literature. J Neurosurg 102(3 Suppl):314–317PubMed

57.

Sato H, Sato N, katayama S, Tamaki N, Matsumoto S (1991) Effective shunt-independent treatment for primary middle fossa arachnoid cyst. Childs Nerv Syst 7(7):375–381PubMedCrossRef

58.

Schroeder HW, Gaav MR, Niendorf WR (1996) Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85(2):293–298PubMed

59.

Sgouros S, Chapman S (2001) Congenital middle fossa arachnoid cysts may cause global brain ischaemia: a study with 99Tc-hexamethylpropyleneamineoxime single photon emission computerised tomography scans. Pediatr Neurosurg 35(4):188–194PubMedCrossRef

60.

Shigemori M, Okura A, Takahashi Y, Tokutomi T (1996) New surgical treatment of middle fossa arachnoid cyst. Surg Neurol 45(2):189–192PubMedCrossRef

61.

Sindou M, Guyotat-Pelissou I, Chidiac A, Goutelle A (1993) Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Experience with 75 cases. Acta neurochir 121(3–4):135–139CrossRef

62.

Sirkowski CW, Yamini B, Frim DM (2004) Endoscopic cyst fenestration outcomes in children one year of age or less. Pediatr Neurosurg 40(2):59–63CrossRef

63.

Stachura K, Czepko R (2006) Results of neuroendoscopic treatment of arachnoid cysts in adults. Neurol Neurochir Pol 40(5):391–396PubMed

64.

Stowe LA, Go KG, Pruim J, den Dunnen W, Meiners LC, Paans AM (2000) Language localization in cases of left temporal arachnoid cyst: evidence against interhemispheric rorganization. Brain Lang 75(3):347–358PubMedCrossRef

65.

Sunami K, Saeki N, Sunada S, Hoshi S, Murai H, Kubota M, Takanashi J, Yamaura A (2002) Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children—a clinical entity difficult to detect on neuroimaging study. Brain Dev 24(8):776–779PubMedCrossRef

66.

Sztriha L, Guruaj A (2005) Hippocampal dysgenesis associated with temporal lobe hypoplasia and arachnoid cyst of the middle cranial fossa. J Child Neurol 20(11):926–930PubMedCrossRef

67.

Tamburrini G, Caldarelli M, Massimi L, Di Giuda M, Novegno F, Di Rocco F, Di Rocco C (2005) Prolonged ICP monitoring combined with SPECT studies in children with sylvian fissure arachnoid cysts. Childs Nerv Syst 21:840 CrossRef

68.

Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C (2003) Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst 19(3):159–165PubMed

69.

Tamburrini G, Di Rocco C, Velardi F, Santini P (2004) Prolonged intracranial pressure (ICP) monitoring in non-traumatic pediatric neurosurgical diseases. Med Sci Monit 10:MT53–MT63PubMed

70.

Wang PJ, Lin HC, Liu HM, Tseng CL, Shen YZ (1998) Intracranial arachnoid cysts in children: related signs and associated anomalies. Pediatr Neurol 19(2):100–104PubMedCrossRef

71.

Weber R, Voit T, Lumenta C, Lenard HG (1991) Spontaneous regression of a temporal arachnoid cyst. Childs Nerv Syst 7(7):414–415PubMedCrossRef

72.

Wester K (1999) Peculiarities of intracranial arachnoid cysts: location sidedness and sex distribution in 126 consecutive patients. Neurosurgery 45(4):775–779PubMedCrossRef

73.

Wester K, Helland CA (2008) How often do chronic extra-cerebral haematomas occur in patients with intracranial arachnoid cysts? J Neurol Neurosurg Psychiatry 79(1):72–75PubMedCrossRef

74.

Wester K, Hugdhal K (1995) Arachnoid cysts of the temporal fossa: impaired preoperative cognition and postoperative improvement. J Neurol Neurosurg Psych 59:293–298

75.

Yalcin DA, Oncel C, Kaymaz A, Kuolu N, Forta H (2002) Evidence against association between arachnoid cysts and epilepsy. Ep Res 49(3):255–260CrossRef

76.

Yamauchi T, Saeki N, Yamaura A (1999) Spontaneous disappearence of temporo-frontal arachnoid cyst in a child. Acta Neurochir 141(5):537–540CrossRef

77.

Yildiz H, Erdogan C, Yalcin R, Yazici Z, Hakyemez B, Parlak M, Tuncel E (2005) Evaluation of communication between intracranial arachnoid cysts and cisterns with phase-contrast cine MR imaging. AJNR 26:145–151PubMed

78.

Yildiz H, Yazici Z, Hakyemez B, Erdogan C, Parlak M (2006) Evaluation of CSF flow patterns of posterior fossa cystic malformations using CSF flow MR imaging. Neuroradiology 48:595–605PubMedCrossRef

79.

Zaatreh MM, Bates E, Hooper SR, Palmer G, Elmenshawi EE, Courvoisie HE, Greenwood RS (2002) Morphometric and neuropsychologic studies in children with arachnoid cysts. Ped Neurol 26(2):134–138CrossRef

80.

Zada G, Krieger MD, McNatt SA, Bowen I, McComb JG (2007) Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age. Neurosurg Focus 22(2):E1PubMedCrossRef

Title: Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management
Authors: Gianpiero Tamburrini
Mateus Del Fabbro
Concezio Di Rocco
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Child's Nervous System / Issue 5/2008
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-008-0585-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management

Abstract

Background

Purpose

Methods

Results and conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Methods

Results and conclusions

Please log in to get access to this content

Other articles of this Issue 5/2008

Inadvertent intracranial insertion of a soft rubber tube in a patient with Treacher-Collins syndrome: case report and review of literature

Apoptosis seems to be the major process while surface and neural ectodermal layers detach during neurulation

Outcomes after surgery for focal epilepsy in children

Intrathecal chemotherapy for refractory disseminated medulloblastoma

Operative management of growing skull fractures: a technical note

A dose–response relationship research on botulinum toxin type A local intramuscular injections of lower extremity spasticity in children with cerebral palsy