Surgical treatment of arachnoid cysts in the middle cranial fossa in children

Abstract

Intracranial arachnoid cysts (ACs) are benign lesions that are usually incidental findings but can cause neurological symptoms due to the mass effect if they grow. The choice of the optimal surgical treatment for middle cranial fossa (MCF) ACs is still controversial. Such options include neuroendoscopic cystic cisternostomy, microsurgical cystic cisternostomy, cystoperitoneal shunting. Purpose - to conduct a comparative analysis of surgical techniques for the treatment of ACs in MCF; to analyze the results of surgical treatment of ACs in MCF. Materials and methods. Clinical and instrumental results and anamnesis data of all paediatric patients with ACs in MCF who underwent surgical treatment at the SI «Romodanov Institute of Neurosurgery of the NAMS of Ukraine» in 2016-2021 (19 cases) were analysed. 19 patients were selected, 10 of whom were operated on endoscopically, 3 - microsurgically, 6 - underwent cystoperitoneal bypass. Results. Improvement of the condition or disappearance of symptoms was observed in 9 (90%) out of 10 patients who underwent endoscopic surgery, in 2 (63%) out of 3 patients who were treated with microsurgery, in 6 (100%) out of 6 patients who underwent surgical treatment by gastric bypass. The frequency of repeated surgical interventions in the case of primary surgery by endoscopic method was on average 0.5 operations per 1 case, microsurgical method - on average 0.3 operations per 1 case, bypass surgery - on average 2 operations per 1 case. The length of stay in the hospital after surgery was: for patients undergoing bypass surgery - from 14 to 47 days (average - 24 days); for patients undergoing microsurgery - from 7 to 25 days (average - 13 days); for patients undergoing endoscopic surgery - from 7 to 10 days (average - 8 days). Conclusions. All surgical techniques are effective in the treatment of symptomatic ACs in MCF. Endoscopic treatment of symptomatic ACs in MCF allows to achieve a stable regression of clinical manifestations of the disease with a minimal likelihood of reoperation. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.