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Child's Nervous System
Published in: Child's Nervous System 3/2014

01-03-2014 | Original Paper

Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options

Authors: Zarina S. Ali, Shih-Shan Lang, Dara Bakar, Phillip B. Storm, Sherman C. Stein

Published in: Child's Nervous System | Issue 3/2014

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Abstract

Purpose

A variety of surgical approaches for the treatment of pediatric intracranial arachnoid cysts exist. In an effort to identify the optimal surgical treatment for this disorder, we developed a decision analytic model to evaluate outcomes of four surgical approaches in children. These included open craniotomy for cyst excision, open craniotomy for cyst fenestration, endoscopic cyst fenestration, and cystoperitoneal shunting.

Methods

Pooled data were used to create evidence tables, from which we calculated incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) for the four surgical treatments. Our study incorporated data up to 5 years postsurgery.

Results

We analyzed 1,324 cases from 36 case series. There were no significant differences in outcome among the four surgical strategies. The QALYs (maximum of 5) for surgical approaches resulted in a range from 4.79 (for open craniotomy and excision) to 4.92 (for endoscopic fenestration).

Conclusions

Overall quality of life is comparable between patients undergoing open craniotomy for cyst excision or fenestration, endoscopic fenestration, and cystoperitoneal shunting up to 5 years after surgery. While each approach offers unique advantages and disadvantages, an individualized treatment strategy should be employed in the setting of surgical outcome equipoise.
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Metadata
Title
Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options
Authors
Zarina S. Ali
Shih-Shan Lang
Dara Bakar
Phillip B. Storm
Sherman C. Stein
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 3/2014
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-013-2306-2

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