gms | German Medical Science

Objective: Intracranial arachnoid cysts are benign space-occupying lesions, which may be symptomatic with increased size. In a large MR imaging series (11,738 children were included) a prevalence of 2.6% were found with a predominance in males and localization in the temporal fossa on the left. The aim of this study was to analyze all by surgery treated children with intracranial arachnoid cyst regarding size, location, symptoms, revision rates and underlying causes.

Methods: The authors retrospectively evaluated all consecutive patients with intracranial arachnoid cyst treated by surgery between 1/2009 and 12/2015 in a children`s hospital. Children, who were previously operated in another institution were excluded.

Results: In our series 43 children (32 males, 11 females) were included. In 37.2% (n=16) the arachnoid cyst was located in the temporal fossa. The posterior fossa or the suprasellar region were affected in 8 cases each. 5 patients had cysts in the interhemispheric fissure and and 2 intraventricular and quadrigeminal cysts. We found as well 1 cyst at the convexity and one with bihemispherical manifestation. In 27 cases, an increase in size could be observed. Most children were conspicuous by macrocephaly (58%) and hydrocephalus, sometimes in combination. Five times clinical signs of an increased intracranial pressure were seen, 2 children show a typical sunset phenomenon. Initially we performed microscopic (19) or endoscopic (17) fenestration, in each three cases a shunt insertion or endoscopic fenestration with shunt insertion and one time an endoscopic fenestration and stent implantation was carried out. In the endoscopic group, 5 secondary shunt implantations became necessary due to insufficient resorption of cerebrospinal fluid, in the microscopic fenestration group 2 shunts. In each group one re-windowing of the openings was required. One cerebrospinal fluid fistula were seen without infection. The follow up period ranges from 3 to 83 months.

Conclusion: As recommended in the literature only children with symptomatic arachnoid cysts have been treated surgically. Symptoms and signs were progressive macrocephalus, hydrocephalus, increased intracranial pressure. Initially we prefer as surgical procedure endoscopic or microscopic fenestration. The revision rate is higher in the endoscopic group, however, a re-windowing is possible without additional risks. In case of insufficient resorption of cerebrospinal fluid implantation of a ventriculo- or cystoperitoneal shunt is the method of choice.