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Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period

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Abstract

Purpose

Less than 0.5% of arachnoid cysts are intraventricular in origin. We review our experience with endoscopic surgery for intraventricular arachnoid cysts in children.

Methods

This is a retrospective review of children with intraventricular arachnoid cysts who underwent surgery between 2005 and 2016. Clinical notes and imaging were reviewed.

Results

Twenty-nine patients with endoscopically treated intraventricular arachnoid cysts were identified (M/F = 17:12; median age = 1.47 years, range = 7 days-13 years). All had hydrocephalus at presentation, many had symptoms/signs of raised intracranial pressure, and five (17%) were asymptomatic. Cysts were treated with fenestration into the ventricle alone (ventriculocystostomy [VC], n = 14), fenestration into the ventricle and cisternostomy (ventriculocystostomy plus cisternostomy [VC + C], n = 14), or endoscopic third ventriculostomy alone (n = 1). Six (21%) patients experienced transient and/or conservatively managed complications. Further surgery was required in 12 (41%). Revision-free survival was significantly shorter with VC compared to VC + C (log rank p = 0.049), and the majority of VC/VC + C revisions (n = 8 of 11, 73%) were required within 6 months of initial endoscopic surgery. One (3%) patient died during follow-up, from unrelated pathology. After a median follow-up of 67.5 months in survivors (range = 5.5–133.5 months), 24 (83%) cases were clinically and radiologically stable without a shunt in situ.

Conclusions

Endoscopic fenestration is safe and effective in most intraventricular arachnoid cysts. Additional cisternostomy at the time of cyst fenestration into the ventricle significantly improved revision-free survival in our cohort. Endoscopic surgery should be the first-line therapy when considering intervention for symptomatic intraventricular arachnoid cysts and for asymptomatic cysts increasing in size on serial imaging.

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Author notes

  1. Phillip Copley and Matthew A. Kirkman contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH, London, UK

    Phillip Copley, Matthew A. Kirkman, Dominic Thompson, Greg James & Kristian Aquilina

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  1. Phillip Copley
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  2. Matthew A. Kirkman
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Correspondence to Kristian Aquilina.

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Copley, P., Kirkman, M.A., Thompson, D. et al. Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period. Childs Nerv Syst 34, 257–266 (2018). https://doi.org/10.1007/s00381-017-3524-9

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