Artikel
Long-term results of endoscopic treatment of arachnoid cysts in children
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Autoren
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Christina Vorbau
- Universitätsmedizin Greifswald , Klinik und Poliklinik für Neurochirurgie , Greifswald, Deutschland
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Steffen Fleck
- Universitätsmedizin Greifswald , Klinik und Poliklinik für Neurochirurgie , Greifswald, Deutschland
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Jörg Baldauf
- Klinik für Neurochirurgie, Ernst-Moritz-Arndt Universität, Greifswald, Deutschland
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Henry W. S. Schroeder
- Ernst-Moritz-Arndt-Universität Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Long-term results of endoscopic treatment of arachnoid cysts in children
Methods: 15 patients underwent endoscopic treatment of arachnoid cysts in our department over a period of 23 years (1993-2015). The age of the patients at the time of treatment ranged from 6 months to 17 years (average 8,2 years). The location of the cysts were Sylvian (9), suprasellar (3), infratentorial (1), intraventricular (1) and one confined to the internal auditory canal. The patient’s symptoms included headache, pathological skull growth, nausea and vomiting, impaired consciousness up to the point of syncope, behavioural disorder and lack of concentration, impaired vision, paraesthesia, speech disorder and precocious puberty. In one patient arachnoid cyst was already diagnosed during perinatal ultrasound. Endoscopic operation techniques were performed by cystocisternostomies (8), ventriculocystostomies (2), ventriculocystocisternostomies (2) and additional partial resection (2). In 5 operations a permanent catheter was used to keep the fenestration hole open. In 2 cases endoscope-assisted microsurgical cystocisternostomies were performed. The cyst in the internal auditory canal was fenestrated by an endoscope-assisted microsurgical procedure.
Results: In 3 of 15 procedures complications appeared as temporary meningitis, which was successfully treated with antibiotics, and one cerebrospinal fluid fistula. Symptoms were completely relieved in 5 patients and improved markedly in 10 cases. The average follow up period was 144.5 months ranging from 6 to 283 months. In 13 patients, MR imaging was performed. All cysts decreased in size. In one patient, an endoscopic revision was required because the first endoscopic attempt failed. After the second surgery, the cyst decreased in size. In two cases shunt placement was required.
Conclusion: Endoscopic treatment is a safe and effective treatment in arachnoid cysts providing excellent long-term results, and should be first treatment option to avoid shunt materials.
