Document Detail

Endoscopic treatment of suprasellar arachnoid cysts in children.
MedLine Citation:
PMID:  21721882     Owner:  NLM     Status:  MEDLINE    
OBJECT: Suprasellar arachnoid cysts (SACs) are rare, comprising approximately 10% of all intracranial arachnoid cysts. Although neuroendoscopic management is emerging as a safe effective alternative to microsurgery, the type of endoscopic surgery whether ventriculocystostomy (VC) or ventriculocystocisternostomy (VCC) is still controversial. This study evaluates the role of endoscopy in the treatment of SACs in children. It compares VC and VCC to determine which procedure is superior in the long term.
METHODS: Twenty-five children (14 boys and 11 girls; mean age 26 months) with symptomatic SACs associated with hydrocephalus are the subject of this study. According to the surgical procedure adopted, patients were divided into 2 groups. Patients in Group A (11 patients) underwent VC with a mean follow-up of 55 months, and those in Group B (14 patients) underwent VCC with a mean follow-up of 64.7 months.
RESULTS: Both procedures proved to be effective clinically and radiologically. The incidence of improvement of hydrocephalus-related symptoms was 63.6% in Group A compared with 85.7% in Group B. Improvement in cyst size and hydrocephalus after VC was 81.8% and 63.6%, respectively, compared with 100% and 85.7%, respectively, after VCC. There were no deaths or permanent morbidity, and no patient was left with a permanent shunt. Recurrence occurred in 3 cases after VC (27.3%), whereas no recurrence (0%) was encountered after VCC. At a second endoscopic procedure, the fenestration was found to be closed in all 3 recurrent cases.
CONCLUSIONS: An endoscopic procedure is recommended in the treatment of SACs in children because it is simple, effective, minimally invasive, and associated with low morbidity and mortality rates. Both procedures, VC and VCC, proved to be almost equally effective clinically and radiologically. Nevertheless, because of the statistically significant difference between the incidence of recurrence after VC and VCC during long-term follow-up, the author concludes that VCC should be considered as the procedure of choice in the treatment of these cases. The important finding of reclosure of the VC fenestration in the recurrent cases underscores the significance of performing cystocisternostomy at initial surgery to guard against cyst recurrence.
Nasser M F El-Ghandour
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  8     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-04     Completed Date:  2011-08-29     Revised Date:  2012-04-05    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  6-14     Citation Subset:  IM    
Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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MeSH Terms
Arachnoid Cysts / diagnosis,  surgery*
Child, Preschool
Endoscopy / methods*
Follow-Up Studies
Hydrocephalus / diagnosis,  surgery
Magnetic Resonance Imaging
Postoperative Complications / diagnosis,  surgery
Tomography, X-Ray Computed
Ventriculostomy / methods*
Comment In:
J Neurosurg Pediatr. 2012 Mar;9(3):231-8   [PMID:  22380950 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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