Treatment Options for Intracranial Arachnoid Cysts: A Retrospective Study of 69 Patients
The best surgical treatment of cerebral arachnoid cysts is yet to be established. Treatment options are shunting, endoscopic fenestration or microsurgical fenestration through craniotomy.
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Abstract The best surgical treatment of cerebral arachnoid cysts is yet to be established. Treatment options are shunting, endoscopic fenestration or microsurgical fenestration through craniotomy. Data from 69 patients with cerebral arachnoid cysts treated in our institution between 1997 and 2007 were reviewed. Cysts were located infratentorially in 20% (n = 14) and supratentorially in 80% (n = 55); of these 73% (n = 40) were in the middle cranial fossa. Mean cyst size was 61 mm (range 15–100 mm). The most common symptoms were headache (51%), dizziness (26%), cranial nerve dysfunction (23%), seizure (22%), nausea and vomiting (18%), and hemiparesis (13%). Surgery was performed in 83% (n = 57). First-line treatments were microsurgical fenestration (n = 30), endoscopic fenestration (n = 15), and cystoperitoneal/ventriculoperitoneal shunting (n = 11). More than one intervention was needed in 42% (n = 24). A particularly high rate of relapse (73%) was observed after endoscopic fenestration, following which 11 patients were admitted for reoperation. By comparison, only eight patients (28%) managed with microsurgical fenestration and four (36%) in the shunted group needed a second surgical procedure. Mean follow-up was 30 months. In the surgical series 79% (n = 45) had a good outcome. We conclude that the surgical treatment of arachnoid cysts has an overall good outcome. In our institution the best results were obtained with microsurgical decompression through craniotomy. Keywords Arachnoid cyst • Microsurgical fenestration • Endoscopic fenestration • Shunting
Introduction Arachnoid cysts are benign, congenital, intra-arachnoid collections of clear, colorless fluid with the same osmolarity as cerebrospinal fluid (CSF) though chemically dissimilar [3]. On brain imaging studies, arachnoid cysts are a common incidental finding with a prevalence of 1.1% in adults [28] and 2.6% in children [1]. Cysts are located along the craniospinal axis, with a strong predilection for the temporal fossa [18, 22, 23, 29], predominantly on the left side [9]. Although the majority of arachnoid cysts are asymptomatic, a wide range of symptoms can be present depending on the anatomical location and intracystic pressure [8, 11]. Symptoms include headache, nausea and vomiting, seizures, macrocephaly, endocrine dysfunction, cognitive decline, and focal neurological deficits [5, 7, 13, 14, 16, 17, 20, 21]. The treatment of choice is still debated. Shunting procedures have been suggested as first-line treatment by various authors [2, 6, 10]. Obtaining shunt independence by cyst excision [24], fenestration through craniotomy or the keyhole approach [15], or endoscopic fenestration [12, 19, 26] has also been recommended. The aim of this present study was to characterize the clinical presentation, imaging features, and surgical management with an emphasis on treatment options and their outcome. Current treatment options in our institution are shunting procedures, endoscopic fenestration and microsurgical fenestration through craniotomy.
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