Management of pediatric Sylvian arachnoid cysts. A retrospective study.

Background and purpose: Neurosurgical approaches in Sylvian arachnoid cysts include microsurgery, endoscopy, and shunting. Yet, their relative safety and efficacy is still under debate. This retrospective study evaluated 36 pediatric patients with Sylvian arachnoid cysts and treated with different surgical types to contribute to global data.

Methods: The study included 24, 8, and 4 patients receiving endoscopic, microsurgical, and shunt surgeries, respectively. Preoperative and postoperative assessments included the patients' demographics and symptoms, cyst size and type, psychomotor status, length of hospital stay, and complications with a mean follow-up of 37.3 months.

Results: All types of surgeries alleviated headaches and seizures in most of the patients. Shunt operations led to the highest reduction in cyst size in the early postoperative period and relieved cranial palsy in all patients. Microsurgery achieved greater healing regarding hemiparesis and seizures, and reduced cyst size more effectively in the early postoperative period than endoscopy. Complication rates were similar between the endoscopy and microsurgery groups.

Conclusion: Arachnoid cyst surgery is efficient and relatively safe. The higher efficacy of microsurgery may be associated with the lesser chronic presence of cysts in this group rather than its technical superiority. Endoscopic surgery is challenging, yet it may be advocated to avoid craniotomy and shunt complications. Surgical-type decisions for arachnoid cysts should be patient-tailored based on careful preoperative clinical and radiological examinations.