Article
Surgical decision making and outcome for endoscopic treatment of intracranial arachnoid cysts
Search Medline for
Authors
-
Jana Rediker
- Universitätsklinikum des Saarlandes, Homburg, Deutschland
-
Stefan Linsler
- Universitätsklinikum des Saarlandes, Homburg, Deutschland
-
Joachim Oertel
- Universitätsklinikum des Saarlandes, Homburg, Deutschland
| Published: | June 18, 2018 |
|---|
Outline
Text
Objective: Indication for surgical treatment and surgical strategies for intracranial arachnoid cysts are still controversially discussed issues. The objective of this analysis is to evaluate surgical decision making, endoscopic strategies, and outcome of the authors' recent cases of intracranial arachnoid cysts.
Methods: Data of all patients who underwent pure endoscopic surgery for intracranial arachnoid cyst at the authors' department between January 2011 and August 2017 were retrospectively reviewed. A total of 28 patients with 29 radiologically diagnosed intracranial arachnoid cysts were treated in 30 endoscopic surgical procedures. Particular respect was given to the indications for surgery, surgical techniques, and outcome.
Results: At the time of surgery, patients (n=28) were between one month and 81 years old (mean 37.4 years). There were seven pediatric (24.1%) and 22 adult (75.9%) patients. Cyst locations were temporal (34.5%), paraxial (20.6%), intraventricular (17.2%), retrocerebellar (13.8%), quadrigeminal (3.4%), prepontine (3.4%), suprasellar (3.4%) and lateral to the cerebellum in the cerebello-pontine angle (3.4%). Indication for surgery was made due to symptoms in most of the cases (93.1%), followed by mass effect (86.2%), lack or decrease of communication in cisternography (55.2%), increase in cyst size (20.7%), hydrocephalus (13.8%), intracystic or subdural hemorrhage/hygroma (6.9%), and necessity for histopathological diagnostic (6.9%). Cystocisternostomy was performed in 53.3%, cystoventriculostomy in 23.3%, ventriculocystostomy in 16.7%, ventriculocystocisternostomy in 3.3%, and transnasal-transsphenoidal resection in 3.3%. Clinical improvement or stable symptom-free condition was achieved in 90.0% and radiological benefit in 60.0%. Transient complications were observed in eight patients, recurrences occurred in two patients, and shunt dependency was documented in one patient. There were no permanent complications and no mortality.
Conclusion: General considerations for surgical decision making can be helpful, but determining the most suitable treatment strategy has to be individually discussed in each case. Pure endoscopic surgery provides good results and low complication rates and is regard as method of choice for intracranial arachnoid cysts.
