Evaluation of the management of arachnoid cyst of the posterior fossa in pediatric population: experience over 27 years

Abstract

The relatively good results using marsupialization or endoscopic cisternostomy as surgical procedure and the high incidence of shunt malfunction buttresses our use of both operations as a first-line surgery at present. Surgical procedure that does not include shunting decreases the ratio of recurrent operation because this kind of complication develops over time and should be consider as a second-line procedure.

Congenital Abnormalities of the Posterior Fossa

“…Macrocephaly, signs of increased intracranial pressure, and developmental delay are possible clinical findings in children with posterior fossa arachnoid cysts, particularly if CSF flow is obstructed (23). However, these cysts may be asymptomatic and discovered incidentally.…”

“…However, these cysts may be asymptomatic and discovered incidentally. Overall, children who undergo surgery and shunt placement have a favorable outcome (4,23).…”

Management of subdural hygromas associated with arachnoid cysts

“…In reported series, surgical fenestration of arachnoid cysts has resulted in iatrogenic postoperative subdural hygroma in approximately 4% to 29% of cases. 11,13,18,21,22,25,30,36,44,48,60,66,69,70,72,84 The incidence of asymptomatic subdural collections following surgical fenestration may be even higher. 66 As with idiopathic or posttraumatic hygromas, these postoperative hygromas may cause symptoms of elevated ICP, 72 leading Maixner et al 47 to term this phenomenon "pseudotumor syndrome following surgery for arachnoid cysts."…”

“…1,2,4,24,38,39,77,79,84 Although arachnoid cysts are occasionally symptomatic, most agree that a majority of arachnoid cysts are found incidentally. 1,2,48,60,73 There are reports of cysts arising de novo, 57,63,71 as well as cysts becoming larger or smaller over time, 50,65,67 and even spontaneously resolving. 19,35,67,74,80,82 We recently reported on the natural history of these lesions in children 2 and adults 1 and found a generally benign natural history.…”

“…7,18,21,25,27,28,37,44,46,48,50,55,85 In some cases, previously asymptomatic arachnoid cysts may rupture, causing a symptomatic hygroma in the subdural space. 3,6,9,11,12,15,18,23,26,28,42,58,62,68,82 Most prior reports have advocated surgical treatment for arachnoid cyst-associated subdural hygromas.…”