Characteristic and management of pediatric arachnoid cysts: A case series: Pediatric arachnoid cysts

Abdulfettah  Tümtürk; Nimetullah Alper  Durmuş; Süreyya Burcu  Görkem; Murat  Çiftçi; Mehmet  Canpolat; Hüseyin  Per

doi:10.28982/josam.1028090

Authors

Abdulfettah Tümtürk Department of Neurosurgery, Acıbadem Hospital, Kayseri, Turkey https://orcid.org/0000-0001-5883-9819
Nimetullah Alper Durmuş Department of Neurosurgery, Kayseri City Training and Research Hospital, Kayseri, Turkey https://orcid.org/0000-0002-7581-790X
Süreyya Burcu Görkem Department of Radiology, Adana City Hospital, Adana, Turkey https://orcid.org/0000-0001-8949-6476
Murat Çiftçi Department of Neurosurgery, Acıbadem Hospital, Kayseri, Turkey https://orcid.org/0000-0003-2780-1804
Mehmet Canpolat Department of Pediatric Neurology, Erciyes University School of Medicine, Kayseri, Turkey https://orcid.org/0000-0002-2197-8433
Hüseyin Per Department of Pediatric Neurology, Erciyes University School of Medicine, Kayseri, Turkey https://orcid.org/0000-0001-9904-6479

DOI:

https://doi.org/10.28982/josam.1028090

Keywords:

Arachnoid cysts, Conservative management, Craniotomy, Cysto-peritoneal shunting, Microsurgical cyst fenestration

Abstract

Background/Aim: Arachnoid cysts (ACs) are the collection of fluid, which is similar in composition to cerebrospinal fluid, within the congenitally duplicated arachnoid membrane. ACs are clinically silent lesions, but sometimes they can manifest themselves with headache, convulsion, focal neurological deficits, cognitive decline, torticollis, and macrocephaly. Although the appropriate surgical approach is less clear, there is a consensus on the need for surgical treatment in symptomatic ACs. This study aims to reveal the advantages and disadvantages of cystoperitoneal shunt and microsurgical fenestration techniques.

Methods: One hundred ninety-one consecutive patients from 1 month to 15 years old with AC were evaluated for suitability. Sixteen patients who underwent surgery were included in the study. Medical records of the patients with AC managed at our institutions were retrospectively collected and analyzed. Sixteen of 191 patients underwent surgical treatment via craniotomy for microsurgical cyst fenestration (CF) and cysto-peritoneal shunting (CS). CF was performed with partial cyst wall excision in all patients.

Results: Seizure was the most common presentation in the patients, followed by headache and trauma, respectively. In our series the most common indications of the surgery were increased intracranial pressure (IICP). CF was performed in nine patients, and CS was performed in seven as the primary treatment. CS-related complications, such as infection (n = 2), dysfunction (n = 2) and intraabdominal abscess (n = 1) were the most commonly observed complications. No infections were observed after CF, but subdural hematoma was observed in one child.

Conclusions: Although the most common symptoms in cases with arachnoid cysts are headache, rare symptoms, such as torticollis, may exist. Due to this, clinicians should reveal the cyst-complaint relationship first. Given the increased complications of CS, in addition to shunt independency and being free from shunt-related complications, the microsurgical CF with wide excision of the membranes seems to be the more preferable surgical option.

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