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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Endoscopic treatment (endoscopic neurosurgery) of intracranial non-neoplastic cysts in pediatric patients

Meeting Abstract

Suche in Medline nach

  • corresponding author G. Talamonti - Department of Neurosurgery, Niguarda Ca’ Granda Hospital, Milan, Italy
  • G. D’Aliberti - Department of Neurosurgery, Niguarda Ca’ Granda Hospital, Milan, Italy
  • M. Collice - Department of Neurosurgery, Niguarda Ca’ Granda Hospital, Milan, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.05.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc070.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Talamonti et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The Authors report a consecutive series of 31 children with intracranial cysts who were managed during the period 2001-2007. Patients with abscesses, parasitic, tumoral and colloid cysts are not considered in this series. In 27 cases the cysts were malformative (arachnoid and paraventricular), in 4 cases were post-haemorrhagic and/or post-infective (intraventricular).

Age ranged from 3 months to 15 years (mean 5.2 years) and the males/females ratio was 5/4. The cysts had various locations but Sylvian and intraventricular ones were the most frequent. In 5 cases, the cysts were asymptomatic but size > 50 cc and very young age indicated surgery. In 26 cases, there was documented progressive cyst enlargement (2 cases), high intracranial pressure (12 cases), focality (4 cases), hemorrhage (4 cases), hydrocephalus (4 cases).

In all cases treatment was planned to perform the widest possible fenestration between the cysts and the arachnoid space and/or the ventricles. All procedures were image-guided. In all cases, the treatment consisted of endoscopic neurosurgery through a single small burr hole. Three patients with multiple cysts required multiple accesses through different burr holes during the same procedure. Anyway, this approach allowed extended dissection of neuro-vascular structures and adequate fenestrations in 29 cases, while, in 2 cases the procedure had to be converted in endoscopic assisted microsurgery through a key-hole approach. Wide exposure of skull base vessels and cranial nerves could be obtained in all cases of Sylvian and posterior fossa cysts. In 4 cases a stent was left in side to maintain the patency of the fenestration. Third ventriculo-cisternostomy and aqueductoplasty were associated to the procedure respectively in 4 and in 3 cases. In 2 cases, a ventriculoperitoneal shunt was contextually placed.

There was neither mortality nor major morbidity. One patient experienced wound leak that could be conservatively managed. Another child complained for transitory mild facial palsy that completely resolved within 3 months. Three patients required re-operation: one owing to the development of a “de novo” cyst; another one due to the recurrence of multiloculated intraventricular post-hemorragic cysts; and the last one because of her associated hydrocephalus resulted not controlled thus requiring ventriculoperitoneal shunting.

During the follow-up (1 to 7 years, mean 2.3 years), 27 patients (88%) resulted clinically improved or even cured whereas 4 (12%) remained clinically unchanged (above all as to headache). No patient worsened. From the point of view of neuroradiology, the cysts decreased in 20 cases (61%) and remained unchanged in 11 patients (39%). Apart from the aforementioned case of recurrence of multiloculated intraventricular cysts, in no other case the cyst recurred or increased. No correlation was found between clinical outcome and postoperative cyst size: clinical improvement was seen in all cases of unchanged cyst size; on the other hand, all patients with unchanged symptoms had obtained cyst decrease.

This relatively wide series of endoscopic neurosurgery for pediatric intracranial cysts allows some conclusions: modern endoscopic techniques represent a safe and effective treatment modality for cysts in all location (even Sylvian and posterior fossa cysts). Neuroendoscopy now permits to create communications between cysts and cisterns as wide as by microsurgery. Since the safety and efficacy, maybe more aggressive indications could be considered for asymptomatic patients.