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Child's Nervous System : ChNS :... Jun 2024Children diagnosed with suprasellar arachnoid cysts often concurrently have hydrocephalus. This study aims to classify the relationship between suprasellar arachnoid...
PURPOSE
Children diagnosed with suprasellar arachnoid cysts often concurrently have hydrocephalus. This study aims to classify the relationship between suprasellar arachnoid cysts and hydrocephalus, discussing surgical strategies-shunting or neuroendoscopic approaches-and their sequence, based on this classification.
METHODS
A retrospective analysis was conducted on 14 patients diagnosed with suprasellar arachnoid cysts and hydrocephalus, treated surgically by the first author between January 2016 and December 2020. Clinical features, radiological findings, surgical strategies, and outcomes were reviewed. The classification of the relationship between the suprasellar arachnoid cysts and hydrocephalus was developed and illustrated with specific cases. Recommendations for future surgical management based on this classification are provided.
RESULTS
We classified the relationship between suprasellar arachnoid cysts and hydrocephalus into three categories. SACH-R1, the direct type, represents cases where the cysts cause obstructive hydrocephalus. Here, neuroendoscopic ventriculocystocisternostomy (VCC) effectively treats both conditions. SACH-R2, the juxtaposed type, involves concurrent occurrences of cysts and hydrocephalus without a causative link. This is further subdivided into SACH-R2a, where acute progressive communicating hydrocephalus coexists with the cyst, initially managed with a ventriculoperitoneal shunt, followed by VCC upon stabilization of hydrocephalus; and SACH-R2b, where the cyst coexists with chronic stable communicating hydrocephalus, first addressed with VCC, followed by monitoring and potential secondary shunting if needed. Key factors differentiating SACH-R2a from SACH-R2b include the patient's age, imaging signs of fourth ventricle and cisterna magna enlargement, and the rapid progression or chronic stability and severity of hydrocephalus symptoms. SACH-R3, the reverse type, describes scenarios where shunting for hydrocephalus leads to the development or enlargement of the cyst, managed via neuroendoscopic VCC with precautions to prevent infections in existing shunt systems.
CONCLUSION
The simultaneous presence of suprasellar arachnoid cysts and hydrocephalus requires a nuanced understanding of their complex relationship for optimal surgical intervention. The analysis and classification of their relationship are crucial for determining appropriate surgical approaches, including the choice and sequence of shunting and neuroendoscopic techniques. Treatment should be tailored to the specific type identified, rather than blindly opting for neuroendoscopy. Particularly for SACH-R2a cases, we recommend initial ventriculoperitoneal shunting.
PubMed: 38822205
DOI: 10.1007/s00381-024-06478-6 -
Child's Nervous System : ChNS :... Apr 2024In children, interhemispheric arachnoid cysts (IHACs) are rare lesions often associated with corpus callosum dysgenesis. It is still controversial about surgical...
OBJECTIVE
In children, interhemispheric arachnoid cysts (IHACs) are rare lesions often associated with corpus callosum dysgenesis. It is still controversial about surgical treatments for IHACs. We aim to report our experience with pediatric IHAC patients and evaluate surgical courses and neurological developments.
METHODS
Pediatric IHACs treated between 2001 and 2021 were reviewed retrospectively. IHAC was observed until they represented rapid cyst enlargement or neurological symptoms. Cyst fenestration was done by microscope or endoscope, depending on the IHAC's location. Cyst size and corpus callosum dysgenesis were evaluated with neuroimaging. Neurological development was assessed from medical records at the last follow-up.
RESULTS
Fifteen children received cyst fenestration surgery (mean age 11.4 months). Eleven patients (73.3%) under observation showed rapid cyst enlargement in a short period (median 5 months). Cysto-ventriculostomy (CVS) and cysto-cisternostomy (CCS) regressed the cyst size significantly (p = 0.003). The median follow-up duration was 51 months (range 14-178 months). Corpus callosum dysgenesis was observed in eleven patients (73.3%, complete = 5, partial = 6). Among eight patients (53.3%) having developmental delay, five patients (33.3%) showed speech delay, including one patient with intractable seizures.
CONCLUSION
Pediatric IHACs frequently present within 1 year after birth, with rapid cyst enlargement. CVS and CCS were effective in regressing the cyst size. Corpus callosum dysgenesis accompanied by IHAC might have a risk of language achievement; however, development delay could rely on multifactorial features, such as epilepsy or other brain anomalies.
Topics: Child; Humans; Infant; Arachnoid Cysts; Retrospective Studies; Agenesis of Corpus Callosum; Ventriculostomy; Nervous System Malformations; Magnetic Resonance Imaging
PubMed: 38051311
DOI: 10.1007/s00381-023-06243-1 -
World Neurosurgery Oct 2023To study patients with spinal arachnoid cysts, who underwent cyst excision with dural defect repair or marsupialization, and their outcomes.
OBJECTIVE
To study patients with spinal arachnoid cysts, who underwent cyst excision with dural defect repair or marsupialization, and their outcomes.
METHODS
The retrospective analysis involved reviewing the records of 38 patients who underwent surgical treatment for spinal arachnoid cysts in the Department of Neurosurgery at Christian Medical College, Vellore, between August 2004 and December 2022. The study examined the demographics, clinical presentation, imaging, surgical intervention, and outcomes of these patients.
RESULTS
The majority of patients in the study were male (29/38, with 76.3%) and the thoracic region was the most common location for the cyst (17, with 44.7%). Weakness was the primary complaint and 94.7% of patients had myelopathy. The bladder was affected in 13 patients (34.2%). Of the 38 patients, 26 (71%) had cysts in extradural locations, while the rest were intradural. In total, 45.5% of intradural cysts were located in the ventral region. Seventeen (65.4%) had dural defects along the root sleeve and 29 (76.3%) underwent complete excision. All extradural cysts underwent complete excision and repair of the dural defect. Thirty patients (78.9%) experienced improved outcomes with reduced spasticity and improved weakness. One patient developed new-onset weakness postoperatively due to epidural hematoma. The mean follow-up period was 41 months and one patient experienced a recurrence.
CONCLUSIONS
Spinal arachnoid cyst is a rare benign spinal condition that is typically treated with surgery in symptomatic patients. Surgical intervention may involve either the excision of the cyst or marsupialization.
PubMed: 37544604
DOI: 10.1016/j.wneu.2023.07.151 -
Child's Nervous System : ChNS :... May 2024Intracranial arachnoid cysts are benign collections of cerebrospinal fluid that are often asymptomatic and discovered incidentally. An interhemispheric location of these...
BACKGROUND
Intracranial arachnoid cysts are benign collections of cerebrospinal fluid that are often asymptomatic and discovered incidentally. An interhemispheric location of these lesions is rare, with only a few such cases reported in the literature. Though spontaneous regression of arachnoid cysts has been described in other locations, to date this phenomenon has not been reported in interhemispheric fissure cysts.
OBSERVATIONS
In this report, we describe a patient with a large, multiloculated interhemispheric arachnoid cyst diagnosed on prenatal ultrasound. She did not exhibit neurologic deficits or signs of increased intracranial pressure and was observed with serial imaging. After several years of observation, imaging revealed spontaneous and progressive decrease in the cyst size.
LESSONS
We illustrate a case of regression of an interhemispheric arachnoid cyst in a pediatric patient. To our knowledge, this is the first reported case of spontaneous shrinkage of an arachnoid cyst in this location. Although the current presentation is rare, this reporting adds to the current understanding of natural history of arachnoid cysts and provides an example of radiographical improvement without intervention of a cyst located within the interhemispheric fissure.
PubMed: 38762563
DOI: 10.1007/s00381-024-06464-y -
World Neurosurgery Feb 2024The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory...
OBJECTIVE
The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory recommendations in the literature, which is limited to mostly case reports. We aimed to provide a comprehensive summary and analysis of symptoms, operative techniques, outcomes, and recurrence of all available surgical cases of AC of the CPA to date.
METHODS
A systematic literature search was performed in May 2022 querying several scientific databases. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgical procedures were performed.
RESULTS
A total of 55 patients from the literature and 5 treated at our institution were included. Mean patient age was 29 years (range, 0.08-79 years), with nearly twice (1.7×) as many female as male patients (37 female, 22 male). Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of patients with hearing loss, 44% reported a return to normal. The rate of mortality was 1.69%, and 10% of tumors recurred (mean follow-up 2.3 years [range, 0-15 years].
CONCLUSIONS
Symptomatic AC of the CPA is rare. It exhibits a proclivity for females and commonly manifests with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for patients with severe symptoms, surgical decompression is an effective tool for symptom alleviation and recovery.
Topics: Humans; Male; Female; Infant, Newborn; Infant; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Cerebellopontine Angle; Hearing Loss; Headache; Vertigo; Deafness; Arachnoid Cysts; Ataxia
PubMed: 38070740
DOI: 10.1016/j.wneu.2023.12.018 -
Child's Nervous System : ChNS :... Oct 2023During the last 30 years, the neurosurgeons have witnessed a revolution in the practice of interventricular surgery. The advent of neuroendoscopy at the end of the... (Review)
Review
During the last 30 years, the neurosurgeons have witnessed a revolution in the practice of interventricular surgery. The advent of neuroendoscopy at the end of the 1980s has allowed a minimally invasive management of a very large series of pathologies in pediatric neurosurgery ranging from hydrocephalus to arachnoid cyst to intraventricular tumors. The progresses in the management of hydrocephalus, intracranial cyst, and the fluid filled collection nevertheless has been more rapid and radical due to the simpler equipment that is necessary to perform this kind of surgery. The intraventricular tumors instead have been addressed in a slower way, and for many years, the only endoscopic procedure that was allowed on interventricular tumors was a biopsy associated with the management of hydrocephalus. Only very small tumors have been considered operable for complete removal during many years due to the limitations of the neuroendoscopic equipment and to the small calibers of the working channel. More recently, the advent of new devices and new surgical techniques are offering new perspectives on the possibility of intraventricular tumor surgery in children. In this review, we describe the historical perspective of the learning curve of intraventricular tumor surgery under neuroendoscopic control and try to offer a view of the future perspective in the removal of larger intraventricular tumors, analyzing the main indications for intraventricular endoscopic tumor surgery. We offer as well an historical perspective of the evolution of skull base surgery and endonasal transsphenoidal approach for skull-based tumors in children. This kind of surgery that has acquired widespread acceptance for many pathologies in adult age has diffused more slowly in pediatric neurosurgery due to the anatomical limitation observed in these age range. Also in this field, the slow evolution of the technique and of the technology available to neurosurgeons has allowed a very significant expansion of indication for the minimally invasive removal of skull base tumors in children.
Topics: Adult; Humans; Child; Neuroendoscopy; Skull Base Neoplasms; Cerebral Ventricle Neoplasms; Hydrocephalus; Cysts; Skull Base
PubMed: 37589762
DOI: 10.1007/s00381-023-06110-z -
Asian Journal of Neurosurgery Sep 2023This article reports the management of a case of a 32-year-old male who presented with progressive weakness in the lower limbs and spastic paraparesis secondary to...
This article reports the management of a case of a 32-year-old male who presented with progressive weakness in the lower limbs and spastic paraparesis secondary to an intramedullary arachnoid cyst (IMAC). For literature review, the authors used the phrase "intramedullary arachnoid cyst" in PubMed search engine. 23 articles describing cases with IMAC were included in this review, with a total of 26 patients. We report a case with long term recurrant intramedullary arachnoid cyst and present a review on spinal intramedullary arachnoid cyst. IMAC is showing bimodal incidence and trending to occur below 10 years and after 30 years. However, rarely, it should be considered in the differential diagnosis of intramedullary cystic lesions. Authors suggest doing laminoplasty or fusion for the pediatric patients to prevent kyphoscoliosis deformity in the long run, but doing early surgery to gain better outcome. Resection of the cyst wall should be done as much as possible; if it could not be achieved, then marsupialization or cysto-subarachnoid shunt should be considered. Aspiration alone or fenestration is not enough to eradicate the cyst. Long-term and prospective studies are recommended to achieve the best treatment options. Review supports early surgical treatment of symptomatic IMACs with resection of the cyst wall as much as possible.
PubMed: 38152523
DOI: 10.1055/s-0043-1774380 -
Clinical Neurology and Neurosurgery Jul 2024Symptomatic intracranial arachnoid cysts are treated mainly through surgical resection, endoscopic fenestration, or by implanting cystoperitoneal (CP) shunt. However,...
OBJECTIVE
Symptomatic intracranial arachnoid cysts are treated mainly through surgical resection, endoscopic fenestration, or by implanting cystoperitoneal (CP) shunt. However, the use of a specific technique remains controversial. The purpose of this study is to discuss these surgical modalities in symptomatic patients with intracranial arachnoid cysts (ACs) and investigate which has better outcomes and less complications by comparing variable preoperative and postoperative parameters.
METHODS
An analysis of thirty-nine symptomatic patients who underwent intracranial arachnoid cyst surgery in the department of neurosurgery between 2009 and 2023 was performed. Patients were retrospectively compared based on age group, gender, anatomical location, laterality, type of intervention, clinical and volumetric changes, postoperative complications and outcome.
RESULTS
Of the 39 patients, 20 patients (51.28 %) received CP shunt. Eleven patients (28.2 %) underwent endoscopic fenestration, and 8 patients (20.5 %) had surgical resection. The age at the time of first operation ranged from 1 month to 59.9 years (mean age: 16.8 years), and the pediatric patients were 25 (64.1 %). The most common initial symptom was headache which was observed in 19 patients (48.7 %), followed by seizure in 12 patients (30.8 %), vomiting in 11 patients (28.2 %), visual dysfunction in 8 patients (20.5 %), drowsiness in 8 patients (20.5 %), visual symptoms in 8 patients (20.5 %), cognitive impairment in 4 patients (10.3 %), focal neurological deficits in 3 patients (7.7 %), and cranial nerve involvement in 1 patient (2.6 %). 24 patients (61.5 %) showed improvement while in 15 patients (38.5 %) the symptoms persisted or worsened. Postoperatively, patients were followed up for an average of one year. The highest improvement rate was noted in endoscopic fenestration with 9 improved patients (81.8 %), followed by surgical resection with 5 symptom-free patients (62.5 %). The worst outcomes were seen in cystoperitoneal shunt with only half of the patients were relieved (50 %). Complications developed in 2 patients (25 %) who underwent surgical resection, 5 patients (45.5 %) who had endoscopic fenestration, and 13 patients (65 %) who had cystoperitoneal shunting.
CONCLUSION
Endoscopic fenestration has the highest improvement rate, the lowest serious complications along with being the least invasive technique. These features make it the optimal modality in treatment of ACs. Surgical resection or cystoperitoneal shunt can be considered as secondary techniques when patients report unchanged or worsening symptoms.
Topics: Humans; Arachnoid Cysts; Male; Female; Adult; Middle Aged; Young Adult; Treatment Outcome; Adolescent; Child; Child, Preschool; Infant; Retrospective Studies; Neurosurgical Procedures; Postoperative Complications; Cohort Studies
PubMed: 38754304
DOI: 10.1016/j.clineuro.2024.108317 -
Pediatric Neurosurgery Jan 2024Intracranial Arachnoid Cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored, however, a small percentage...
INTRODUCTION
Intracranial Arachnoid Cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored, however, a small percentage may enlarge and require surgical intervention. This study aimed to identify clinical risk factors in patients with IAC who underwent surgery versus those who did not.
METHODS
We conducted a retrospective chart review from 2009 to 2021 at a free-standing children's hospital. A total of 230 patients diagnosed with an IAC aged 0 to 21 years of age were included in the study. Data on demographics, imaging and neurological follow-up were analyzed.
RESULTS
Out of 230 patients, 45 (19.6%) underwent surgery. At time of IAC diagnosis, the surgical patients were younger (median age 1.1 years), and their median cyst volume was larger (41.7cm3), compared to non-surgical patients (median age 5.9 years, volume 11.8cm3, respectively). Headache was the most common reason for initial imaging in non-surgical patients (54/185, 29.2%) while prenatal ultrasound (11/45, 24.4%) and macrocephaly (11/45, 24.4%) were the most common reasons for surgical patients. The majority of both surgical and non-surgical patients had the IAC incidentally found (41/45, 91.1% and 181/185, 97.8%, respectively). Surgery relieved symptoms in 38/45 (84.4%) patients. Cyst volume and age were predictors of increased odds of having surgery.
DISCUSSION/CONCLUSION
Patients who underwent surgery were younger and had larger cyst volumes at time of diagnosis. The majority of the IAC were found incidentally and remained stable over prolonged follow up. The majority of the patients experienced relief of symptoms post-surgical intervention. There is a greater odds of having surgical treatment with decreased age and greater cyst volume at diagnosis and therefore these patients should be monitored closely for development of symptoms indicating need for surgical intervention.
PubMed: 38228110
DOI: 10.1159/000536284 -
BMC Pediatrics Aug 2023Migraine and tension-type headache are common primary headaches in children. There is a risk of developing secondary headache in children. The current study was aimed to...
PURPOSE
Migraine and tension-type headache are common primary headaches in children. There is a risk of developing secondary headache in children. The current study was aimed to evaluate magnetic resonance imaging findings (MRI) in children with migraine or tension-type headache.
METHODS
The study was planned in children with migraine or tension-type headaches who have been followed up in the pediatric neurology outpatient clinic with regular office visits for at least two years and had neuroimaging in the last year.
RESULTS
280 patients (187 female patients) datas were studied. 91 (61 female patients) were followed up with the diagnosis of migraine and 189 (126 female patients) with the diagnosis of tension-type headaches. The age of patients was found to be 13.1 ± 3.4 years. Brain tumor was found in one child with tension-type headache who had papilledema. Incidental MRI findings found 7.7% and 12.7% in migraine and tension-type headache, respectively. MRI findings in the study were arachnoid cyst (14), pituitary adenoma (6), mega cisterna magna (6), pineal cyst (3), non-specific gliosis (2) and tumor (1).
CONCLUSION
Arachnoid cysts were found incidental as the most common MRI finding in children with migraine or tension-type headache. The rare life-threatening secondary headache may develop in children. The fundus examination as a complement to the neurological examination can be useful for requesting MRI.
Topics: Child; Humans; Female; Adolescent; Tension-Type Headache; Migraine Disorders; Headache; Magnetic Resonance Imaging; Neuroimaging; Brain Neoplasms
PubMed: 37649015
DOI: 10.1186/s12887-023-04264-y