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Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children

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Abstract

Purpose

The indication of surgical treatment for intracranial arachnoid cysts (ACs) is a controversial issue. In this study, we reviewed surgical outcomes of intracranial ACs that were treated with endoscopic fenestration or microscopic fenestration, which are currently standard practices for surgical treatment of AC. In addition, we also evaluated the validity of current surgical indications.

Methods

We analyzed pediatric patients under 18 years of age who underwent surgical management for intracranial AC between January 2000 and December 2011. Patients with a follow-up period of less than 1 year were excluded. A total of 75 patients were enrolled in this study. These patients were assessed by subjective symptoms and by a clinician’s objective evaluation. The radiological assessment of AC after surgery was also evaluated.

Results

The median age of patients at the initial operation was 5 years. The median follow-up period was 38 months. The goal of surgery was achieved in 28 % (21/75) of patients. The radiological alteration of AC after initial fenestration surgery was diverse. The results of the clinical and radiological assessments did not always coincide. A total of 35 complications occurred in 28 patients. Subdural fluid collection was the most common unexpected radiological complication.

Conclusions

Our study showed that the fenestration procedure for AC produced unsatisfactory clinical improvements compared to the relatively high complication rate. Therefore, surgical treatment for AC should be strictly limited to patients who have symptoms directly related to AC.

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Sources of funding

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A120099).

Conflict of interest

Authors have nothing to disclose, and there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Jung Won Choi, Ji Yeoun Lee, Ji Hoon Phi, Seung-Ki Kim & Kyu-Chang Wang

  2. Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Jung Won Choi, Ji Yeoun Lee, Ji Hoon Phi, Seung-Ki Kim & Kyu-Chang Wang

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  1. Jung Won Choi
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  2. Ji Yeoun Lee
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Correspondence to Kyu-Chang Wang.

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Choi, J.W., Lee, J.Y., Phi, J.H. et al. Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children. Childs Nerv Syst 31, 77–86 (2015). https://doi.org/10.1007/s00381-014-2525-1

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  • DOI: https://doi.org/10.1007/s00381-014-2525-1

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