J Korean Neurosurg Soc.  2012 Oct;52(4):325-333. 10.3340/jkns.2012.52.4.325.

Clinical and Neuroimaging Outcomes of Surgically Treated Intracranial Cysts in 110 Children

• Lee EJ
• Ra YS

• KMID: 2190648
• DOI: http://doi.org/10.3340/jkns.2012.52.4.325

Abstract

OBJECTIVE
The indications and optimal surgical treatments for intracranial cysts are controversial. In the present study, we describe long-term clinical and neuroimaging results of surgically treated intracranial cysts in children. The goal of this study is to contribute to the discussion of the debate.
METHODS
This study included 110 pediatric patients that underwent surgeries to treat intracranial cysts. Endoscopic cyst fenestrations were performed in 71 cases, while craniotomies and cyst excisions (with or without fenestrations) were performed in 30 patients. Cystoperitoneal shunts were necessary for nine patients. Long-term results were retrospectively assessed with medical and neuroimaging records.
RESULTS
Clinical and radiological improvement was reported in 87.3% and 92.8% of cases, respectively, after endoscopic neurosurgery, and in 93.3% and 100% using open microsurgery whereas 88.9% and 85.7% after shunt operation. There were no statistical differences in clinical outcomes (p=0.710) or volume reductions (p=0.177) among the different surgeries. There were no mortalities or permanent morbidities, but complications such as shunt malfunctions, infections, and subdural hematomas were observed in 56% of the patients that had shunt operations. A total of 13 patients (11.8%) underwent additional surgeries due to recurrences or treatment failures. The type of surgery performed did not influence the recurrence rate (p=0.662) or the failure rate (p=0.247).
CONCLUSION
Endoscopic neurosurgeries are less invasive than microsurgeries and are at least as effective as open surgeries. Thus, given the advantages and complications of these surgical techniques, we suggest that endoscopic fenestration should be the first treatment attempted in children with intracranial cysts.

Keyword

Arachnoid cysts; Central nervous system cysts; Congenital; Neuroendoscopy; Child

MeSH Terms

Arachnoid Cysts
Central Nervous System Cysts
Child
Craniotomy
Hematoma, Subdural
Humans
Microsurgery
Neuroendoscopy
Neuroimaging
Neurosurgery
Recurrence
Retrospective Studies
Treatment Failure

Figure

• 

  Fig. 1 Preoperative magnetic resonance images of a 13-year-old female patient with headache (A and B). A Galassi type III arachnoid cyst is observed in the left temporal lobe. In addition, a collapsed left lateral ventricle near the cyst and expansion of the temporal bone over the cyst are also observed (A and B). Three years after endoscopic cyst fenestration, the size of the cyst is markedly decreased and the bony protrusion was reduced (C and D).

• 

  Fig. 2 Magnetic resonance images of a 2-month-old male diagnosed by prenatal ultrasonography. T1-weighted axial and sagittal (A and B) images show a large non-enhancing CSF-like intracerebral cyst in the left temporo-occipital lobe with a well-demarcated margin. The patient underwent craniotomy and a cyst excision. The cystic membrane severely adhered to the basal cistern and the posterior thalamic surface. The pathology confirmed the diagnosis of a neuroglial cyst. Six months after surgery, the size of cyst is markedly decreased (C and D). CSF : cerebrospinal fluid.

• 

  Fig. 3 Comparison of pre- and postoperative cyst volume (cm3) among the three different surgical techniques. Radiological improvements were seen in 92.8% of cases after endoscopic surgeries, 100% after open microsurgeries, and 85.7% after shunt operations (p=0.177).

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