Comparison of surgical techniques for intracranial arachnoid cysts: a volumetric analysis

Kırmızıgöz, Şahin; Doğan, Adem; Kayhan, Sait; Sarıaltın, Sezen Yılmaz; Tehli, Özkan

doi:10.5137/1019-5149.jtn.42463-22.2

Cited by 2 publications

(1 citation statement)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, we did not observe a significant difference in volume reduction between the two surgical options. In contrast, other studies that compared endoscopic fenestration, resection, and shunting could describe a significantly better volume reduction after endoscopic cyst fenestration compared to resection and shunting [ 1 , 14 , 30 ]. In older patients, stereotactic catheter implantation was predominantly used in view of the increased perioperative risk associated with craniotomy.…”

Section: Discussionmentioning

confidence: 91%

Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults

Schmutzer-Sondergeld,

Gencer,

Niedermeyer

et al. 2024

Acta Neurochir

View full text Add to dashboard Cite

Objective The best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for recurrence after surgical treatment, focusing on microscopic/endoscopic approaches as compared to minimally invasive stereotactic procedures in children and adults. Methods In our single-institution retrospective database, we identified all patients treated surgically for newly diagnosed CAC between 2000 and 2022. Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years. Treatment decisions in favor of ME vs. STX were made by interdisciplinary consensus. The primary study endpoint was time to CAC recurrence (TTR). Secondary endpoints were outcome metrics including clinical symptoms and MR-morphological analyses. Data analysis included subdivision of the total cohort into three distinct age groups (AG1, < 6 years; AG2, 6–18 years; AG3, ≥ 18 years). Results Sixty-two patients (median age 26.5 years, range 0–82 years) were analyzed. AG1 included 15, AG2 10, and AG3 37 patients, respectively. The main presenting symptoms were headache and vertigo. In AG1 hygromas, an increase in head circumference and thinning of cranial calvaria were most frequent. Thirty-five patients underwent ME and 27 STX, respectively; frequency did not differ between AGs. There were two (22.2%) periprocedural venous complications in infants (4- and 10-month-old) during an attempt at prepontine fenestration of a complex CAC, one with fatal outcome in a 10-month-old boy. Other complications included postoperative bleeding (2, 22.2%), CSF leaks (4, 44.4%), and meningitis (1, 11.1%). Overall, clinical improvement and significant volume reduction (p = 0.008) were seen in all other patients; this did not differ between AGs. Median follow-up for all patients was 25.4 months (range, 3.1–87.1 months). Recurrent cysts were seen in 16.1%, independent of surgical procedure used (p = 0.7). In cases of recurrence, TTR was 7.9 ± 12.7 months. Preoperative ventricular expansion (p = 0.03), paresis (p = 0.008), and age under 6 years (p = 0.03) were significant risk factors for CAC recurrence in multivariate analysis. Conclusions In patients suffering from CAC, both ME and STX can improve clinical symptoms at low procedural risk, with equal extent of CAC volume reduction. However, in infants and young children, CAC are more often associated with severe clinical symptoms, stereotactic procedures have limited use, and microsurgery in the posterior fossa may bear the risk of severe venous bleeding.

show abstract

Section: Discussionmentioning

confidence: 91%