Surgical fenestration might not be the best option for very young patients with middle fossa arachnoid cysts
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ORIGINAL ARTICLE
Surgical fenestration might not be the best option for very young patients with middle fossa arachnoid cysts Fangyong Dong 1 & Suojun Zhang 1 & Yu Xu 1 & Zirong Chen 1 & Peng Peng 1 & Feng Wan 1 Received: 19 August 2020 / Accepted: 16 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Surgical fenestration is widely accepted as a primary treatment for middle fossa arachnoid cysts (MFACs) in pediatric patients. However, postoperative subdural effusion and/or hydrocephalus always affect treatment outcomes. In this study, we presented our experience of treating MFACs with surgical fenestration in pediatric patients and analyzed the cases complicated by postoperative subdural effusion and/or hydrocephalus, to give insight into the clinical characteristics predisposing the complications. Methods We retrospectively analyzed 21 pediatric cases with MFACs treated by surgical fenestration suffering postoperative subdural effusion and/or hydrocephalus in our department from November 2011 to April 2019. We reviewed the clinical characteristics and treatment outcomes. Results A total of 21 patients, among a total of 53 pediatric patients with MFACs treated by surgical fenestration, developed subdural effusion and/or hydrocephalus postoperatively. The mean age at the time of the initial surgery was 49 months. A total of 75% (6/8) of the patients under 2 years old and 13.3% (6/45) of the older patient group sustaining postoperative subdural effusion and/or hydrocephalus required further surgeries, respectively (Fisher’s exact test, p = 0.001). Notably, among the 21 cases with postoperative subdural effusion and/or hydrocephalus, all the 6 patients under 2 years old needed additional surgeries, while of the other 15 older patients, only 40% (6/15) needed further surgical interventions (Fisher’s exact test, p = 0.019). Conclusion The immature CSF absorption in MFAC patients younger than 2 years old might predispose them to the relatively serious postoperative subdural effusion and/or hydrocephalus. For very young patients with giant MFACs, surgical fenestration might not be the best option. Keywords Middle fossa arachnoid cysts (MFACs) . Children . Fenestration . Subdural effusion . Hydrocephalus
Introduction Intracranial arachnoid cysts are mostly congenital and benign space-occupying lesions with CSF-like fluid collection inside. The middle fossa is the most common location, and the middle fossa arachnoid cysts (MFACs) constitute 30–50% of all arachnoid cysts. Whether children with ACs should undergo surgeries and what management modality should be performed are still in controversy. Manifestations such as neurological deficits, intracranial hypertension, seizures due to
* Feng Wan [email protected] 1
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, 1095, Wuhan 430030, Hubei, People’s Republic of China
expansion or mass effect of the cyst were suggested as indications for neurosurg
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