gms | German Medical Science

Objective: Arachnoid cysts (ACs) are rare and the majority is discovered during childhood. The most common location is the middle cranial fossa. The clinical spectrum is diverse. So far there is no clear recommendation of whether and how symptomatic ACsshould be treated surgically. The optimal surgical approach (microsurgical or endoscopic fenestration, cyst shunts) remains still controversial.

Methods: 33 children (29 boys, 4 girls; mean age at the time of surgery 8.3 years), who were operated for a symptomatic temporal AC between 1995 and 2019 were retrospectively analysed. Chart review and postoperative quality of life assessment (SF-36, KINDL^®, GBI, GCBI) was performed. Cyst volume was measured with Horos^TM software pre- and postoperatively. Clinical outcome was graded into four subgroups (free of symptoms, improved, unchanged, worse). Written consent from the caregivers as well as an ethical approval was obtained.

Results: ACs were located on the right in 13, on the left in 18 and bilateral in 2 cases. There were 4 Galassi type I, 4 type II and 25 type III ACs. Mean follow-up time was 44.5 months (range 1-203 months). 8/33 became symptomatic with posttraumatic cyst rupture and bleeding. 20/33 complained of headaches, 9/33 presented with non-specific symptoms, 5/33 had epilepsy, 4/33 had macrocephaly, 4/33 had psychological problems and 3/33 had hydrocephalus. Preoperative cyst volume varied from 10 to 325.8 cm³ and postoperative (>6 months) from 2.4 to 201.1 cm³. Surgical management consisted in microsurgery in 25/33, endoscopic fenestration in 7/33 and shunt insertion in 1/33. Concerning the outcome, 24/33 (72.7%) patients were symptom-free at >6 months follow-up, 4/33 were clearly improved (12.1%), 5/33 (15.2%) were unchanged. Four patients required repeat surgery for insufficient cyst drainage, one after microsurgical fenestration, 2 after endoscopy and one after an internal shunt. Two subdural hygroma/hematoma required surgical intervention. Subdural effusions resolved completely without intervention in 14/33.

Conclusion: It can be challenging to select the right surgical candidate in temporal ACs, but the long-term outcome is favourable in mostpatients. Microsurgical fenestration seems to be more effective in cyst drainage than other surgical options.