Top

Child's Nervous System

Published in:

01-02-2018 | Original Paper

Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period

Authors: Phillip Copley, Matthew A. Kirkman, Dominic Thompson, Greg James, Kristian Aquilina

Published in: Child's Nervous System | Issue 2/2018

Abstract

Purpose

Less than 0.5% of arachnoid cysts are intraventricular in origin. We review our experience with endoscopic surgery for intraventricular arachnoid cysts in children.

Methods

This is a retrospective review of children with intraventricular arachnoid cysts who underwent surgery between 2005 and 2016. Clinical notes and imaging were reviewed.

Results

Twenty-nine patients with endoscopically treated intraventricular arachnoid cysts were identified (M/F = 17:12; median age = 1.47 years, range = 7 days-13 years). All had hydrocephalus at presentation, many had symptoms/signs of raised intracranial pressure, and five (17%) were asymptomatic. Cysts were treated with fenestration into the ventricle alone (ventriculocystostomy [VC], n = 14), fenestration into the ventricle and cisternostomy (ventriculocystostomy plus cisternostomy [VC + C], n = 14), or endoscopic third ventriculostomy alone (n = 1). Six (21%) patients experienced transient and/or conservatively managed complications. Further surgery was required in 12 (41%). Revision-free survival was significantly shorter with VC compared to VC + C (log rank p = 0.049), and the majority of VC/VC + C revisions (n = 8 of 11, 73%) were required within 6 months of initial endoscopic surgery. One (3%) patient died during follow-up, from unrelated pathology. After a median follow-up of 67.5 months in survivors (range = 5.5–133.5 months), 24 (83%) cases were clinically and radiologically stable without a shunt in situ.

Conclusions

Endoscopic fenestration is safe and effective in most intraventricular arachnoid cysts. Additional cisternostomy at the time of cyst fenestration into the ventricle significantly improved revision-free survival in our cohort. Endoscopic surgery should be the first-line therapy when considering intervention for symptomatic intraventricular arachnoid cysts and for asymptomatic cysts increasing in size on serial imaging.

Al-Holou WN, Yew AY, Boomsaad ZE et al (2010) Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 5:578–585. doi:10.3171/2010.2.PEDS09464 CrossRefPubMed

Basaldella L, Orvieto E, Tos APD et al (2007) Causes of arachnoid cyst development and expansion. Neurosurg Focus 22:1–4. doi:10.3171/foc.2007.22.2.4 CrossRef

Klekamp J (2017) A new classification for pathologies of spinal meninges—part 2: primary and secondary intradural arachnoid cysts. Neurosurgery. doi:10.1093/neuros/nyx050 CrossRefPubMed

Guzel A, Tatli M, Kilincer C, Yilmaz F (2007) Posttraumatic intraventricular arachnoid cyst accompanied by pseudomeningoencephalocele in a child. J Clin Neurosci 14:1210–1213. doi:10.1016/j.jocn.2006.04.016 CrossRefPubMed

Kurokawa Y, Sohma T, Tsuchita H et al (1990) A case of intraventricular arachnoid cyst. How should it be treated? Childs Nerv Syst 6:365–367CrossRefPubMed

Okamura K, Watanabe M, Inoue N et al (1996) Intraventricular arachnoid cyst—on the origin of intraventricular arachnoid cysts. No To Shinkei 48:1015–1021PubMed

Yadav YR, Basoor A, Todorov M, Parihar V (2010) Endoscopic management of large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro. Neurol India 58:481–484. doi:10.4103/0028-3886.65894 CrossRefPubMed

Park SW, Yoon SH, Cho KH, Shin YS (2006) A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern--case report. Surg Neurol 65:611–614. doi:10.1016/j.surneu.2005.07.069 CrossRefPubMed

Erşahin Y, Kesikçi H (2009) Endoscopic management of quadrigeminal arachnoid cysts. Childs Nerv Syst 25:569–576. doi:10.1007/s00381-008-0778-2 CrossRefPubMed

10.

Giussani C, Fiori L, Trezza A et al (2011) Cavum veli interpositi: just an anatomical variant or a potentially symptomatic CSF compartmentalization? Pediatr Neurosurg 47:364–368. doi:10.1159/000336881 CrossRefPubMed

11.

Cinalli G, Spennato P, Columbano L et al (2010) Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases. J Neurosurg Pediatr 6:489–497. doi:10.3171/2010.8.PEDS08491 CrossRefPubMed

12.

Ellis JA, McCormick PC, Feldstein NA, Ghatan S (2015) Transoccipital endoscopic fenestration of atrial cysts causing ventricular entrapment. J Neurosurg Pediatr 15:567–572. doi:10.3171/2014.11.PEDS14227 CrossRefPubMed

13.

Knie B, Morota N, Ihara S et al (2016) Pediatric intraventricular arachnoid cysts in the body of lateral ventricle: surgical outcome and its embryologic background. Childs Nerv Syst 32:2197–2204. doi:10.1007/s00381-016-3203-2 CrossRefPubMed

14.

André A, Zerah M, Roujeau T et al (2016) Suprasellar arachnoid cysts: toward a new simple classification based on prognosis and treatment modality. Neurosurgery 78:370–380. doi:10.1227/NEU.0000000000001049 CrossRefPubMed

15.

Crimmins DW, Pierre-Kahn A, Sainte-Rose C, Zerah M (2006) Treatment of suprasellar cysts and patient outcome. J Neurosurg Pediatr 105:107–114. doi:10.3171/ped.2006.105.2.107 CrossRef

16.

Tamburrini G, D'Angelo L, Paternoster G et al (2007) Endoscopic management of intra and paraventricular CSF cysts. Childs Nerv Syst 23:645–651. doi:10.1007/s00381-007-0327-4 CrossRefPubMed

17.

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

18.

Rappaport ZH (1993) Suprasellar arachnoid cysts: options in operative management. Acta Neurochir 122:71–75CrossRefPubMed

19.

Daneyemez M, Gezen F, Akbörü M et al (1999) Presentation and management of supratentorial and infratentorial arachnoid cysts. Review of 25 cases. J Neurosurg Sci 43:115–121 discussion 122–3PubMed

20.

Boutarbouch M, Ouahabi El A, Rifi L et al (2008) Management of intracranial arachnoid cysts: institutional experience with initial 32 cases and review of the literature. Clin Neurol Neurosurg 110:1–7. doi:10.1016/j.clineuro.2007.08.009 CrossRefPubMed

21.

Stein SC (1981) Intracranial developmental cysts in children: treatment by cystoperitoneal shunting. Neurosurgery 8:647–650CrossRefPubMed

22.

Harsh GR, Edwards MS, Wilson CB (1986) Intracranial arachnoid cysts in children. J Neurosurg 64:835–842. doi:10.3171/jns.1986.64.6.0835 CrossRefPubMed

23.

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

24.

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

25.

Levy ML, Wang M, Aryan HE et al (2003) Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 53:1138–1144 discussion 1144–5CrossRefPubMed

26.

Gangemi M, Colella G, Magro F, Maiuri F (2007) Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 21:276–280. doi:10.1080/02688690701339197 CrossRefPubMed

27.

Gangemi M, Maiuri F, Colella G, Magro F (2005) Endoscopic treatment of quadrigeminal cistern arachnoid cysts. Minim Invasive Neurosurg 48:289–292. doi:10.1055/s-2005-915604 CrossRefPubMed

28.

Spacca B, Kandasamy J, Mallucci CL, Genitori L (2010) Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres. Childs Nerv Syst 26:163–172. doi:10.1007/s00381-009-0952-1 CrossRefPubMed

29.

El-Ghandour NMF (2012) Endoscopic treatment of middle cranial fossa arachnoid cysts in children. J Neurosurg Pediatr 9:231–238. doi:10.3171/2011.12.PEDS11298 CrossRefPubMed

30.

Cincu R, Agrawal A, Eiras J (2007) Intracranial arachnoid cysts: current concepts and treatment alternatives. Clin Neurol Neurosurg 109:837–843. doi:10.1016/j.clineuro.2007.07.013 CrossRefPubMed

31.

Zhao P, Wang X, Li C et al (2013) The effectiveness of neuroendoscopic versus non-neuroendoscopic procedures in the treatment of lateral ventricular cysts: a retrospective medical record review study. BMC Neurol 13:59. doi:10.1186/1471-2377-13-59 CrossRefPubMedPubMedCentral

32.

El-Ghandour NMF (2013) Endoscopic treatment of quadrigeminal arachnoid cysts in children. J Neurosurg Pediatr 12:521–528. doi:10.3171/2013.7.PEDS13155 CrossRefPubMed

33.

Cinalli G, Peretta P, Spennato P et al (2006) Neuroendoscopic management of interhemispheric cysts in children. J Neurosurg 105:194–202. doi:10.3171/ped.2006.105.3.194 CrossRefPubMed

34.

Oertel JMK, Wagner W, Mondorf Y et al (2010) Endoscopic treatment of arachnoid cysts: a detailed account of surgical techniques and results. Neurosurgery 67:824–836. doi:10.1227/01.NEU.0000377852.75544.E4 CrossRefPubMed

35.

Caemaert J, Abdullah J, Calliauw L et al (1992) Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir 119:68–73CrossRefPubMed

36.

Kirollos RW, Javadpour M, May P, Mallucci C (2001) Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718. doi:10.1007/s003810100494 CrossRefPubMed

37.

El-Ghandour NMF (2011) Endoscopic treatment of suprasellar arachnoid cysts in children. J Neurosurg Pediatr 8:6–14. doi:10.3171/2011.4.PEDS1184 CrossRefPubMed

38.

Decq P, Brugieres P, Le Guerinel C et al (1996) Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696–701. doi:10.3171/jns.1996.84.4.0696 CrossRefPubMed

39.

Lee JY, Lee YA, Jung HW et al (2017) Long-term endocrine outcome of suprasellar arachnoid cysts. J Neurosurg Pediatr:1–7. doi:10.3171/2017.1.PEDS16404 PubMed

Title: Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period
Authors: Phillip Copley
Matthew A. Kirkman
Dominic Thompson
Greg James
Kristian Aquilina
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 2/2018
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-017-3524-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Next generation of ventricular catheters for hydrocephalus based on parametric designs

Unexpected finding: dermoid component within a filar lipoma

Apert syndrome: magnetic resonance imaging (MRI) of associated intracranial anomalies

Some of the earliest depictions of the human spine: a glimpse into European history

Correction to: Meta-analysis of adjunctive dexamethasone to improve clinical outcome of bacterial meningitis in children

Can fetus feel pain in the second trimester? Lessons learned from a sentinel event