Surgical decompression of arachnoid cysts: A study on 44 pediatric patients

Abstract

Background: There are yet to clarify some aspects regarding the surgical indications and surgical methods that are at choice for treating ACs. The purpose of the study is to contribute to the ongoing debate on the most appropriate treatment. Materials and methods: We included in the study 44 pediatric patients (aged < 18 years), operated for ACs in the Neurosurgery I Department, of the Emergency Clinical Hospital “Bagdasar-Arseni” in Bucharest, during the period January 2003 to December 2012. The surgical methods were either a craniotomy or cyst shunting. The information regarding these patients was retrospectively assessed based on their clinical and imaging records, and cross checked with the OR protocols. Treatment efficiency was evaluated considering postoperative clinical status, imaging appearance and postoperative complications. Results: 84.1% of the patients reported postoperative disappearance or reduction of symptoms, while 13.6 had the same complaints as prior surgery. Only one patient experienced worsening of symptoms. Follow-up imaging showed cyst disappearance in 29.5% patients and cyst reduction in 61.4% patients. 9.1% had no change in cyst volume. Craniotomy correlated with a better imaging appearance (p=0.02). There was no correlation between improved clinical status and cyst fluid reduction (p=0.6). 9 patients (20.4%), all with temporal cysts, experienced postoperative complications, and 7 of them (15, 9%) needed surgery. There was no severe or permanent dysfunction in any of the patients. 42.8% of the cyst shunting patients suffered postoperative complications, whereas only 10% of the craniotomy patients did. Conclusion: Cyst decompression results in significant clinical improvement and it can be performed with little risk for severe complications. Craniotomy seems to be a better surgical treatment option than cystoperitoneal shunt, with a better neuroimaging appearance and a lower complications rate.