Abstract
The prevalence of intracranial arachnoid cysts (ACs) in children is comprised between 1% and 3%. Most of them are asymptomatic and no treatment is needed.
ACs can be divided into seven types: suprasellar, temporal, intraventricular, quadrigeminal, posterior fossa, convexity, and interhemispheric.
History, pathophysiology, epidemiology, clinical presentation, radiological diagnosis, classifications, association with hydrocephalus, surgical management and techniques, their outcome, and complications are discussed.
Three main techniques are available: open microsurgery, cyst and/or ventriculoperitoneal shunting, and endoscopic fenestration or a combination of these techniques.
Suprasellar, intraventricular, and quadrigeminal ACs appear to be the best indications for endoscopic fenestration with better outcome because of their position in the midline, in intimate relationships with the basal cisterns and ventricles. For a durable endoscopic treatment, the key point is to perform the largest and more fenestrations as possible, allowing a better restoration of cerebrospinal fluid (CSF) pathways. Cortical cysts seem to be best treated by open microsurgery or shunting. Shunt implantation showed a high rate of complications such as malfunctions, shunt dependency, slit cyst syndrome, or chronic tonsillar herniation that can be severe but appears to be the best treatment when indications are well chosen.
When ACs are symptomatic or if hydrocephalus is present, the best treatment remains to create communications between the cyst and normal CSF cisterns or ventricles, each time it is possible with the best mini-invasive single procedure. The amendment of neuroendoscopy tends to treat most of ACs, but microsurgical and shunting procedures still keep a place in selected cases.
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Abbreviations
- 3V:
-
Third ventricle
- 4V:
-
Fourth ventricle
- AC:
-
Anterior commissure
- AcoA:
-
Anterior communicant artery
- Aq.:
-
Aqueduct
- BA:
-
Basilar artery
- BM:
-
Basal membrane of the arachnoid cyst
- BV:
-
Basal vein
- Cereb.:
-
Cerebellum
- Ch.:
-
Optic chiasm
- ChP:
-
Choroid plexus
- clivus:
-
–
- CN:
-
Caudate nucleus
- Cyst:
-
–
- Falx:
-
–
- flocc.:
-
Flocculus
- FM:
-
Foramen of Monro
- GCV:
-
Great cerebral vein
- Hipp.:
-
Hippocampus
- I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII:
-
Cranial nerves
- ICA:
-
Internal carotid artery
- ICV:
-
Internal cerebral vein
- Inf.:
-
Infundibulum
- insula:
-
–
- IPS:
-
Inferior petrosal sinus
- JB:
-
Jugular bulb
- LT:
-
Lamina terminalis
- LV:
-
Lateral ventricle
- MB:
-
Mamillary bodies
- MCA:
-
Middle cerebral artery
- MCF:
-
Middle cranial fossa
- med. obl.:
-
Medulla oblongata
- Mid.:
-
Midbrain
- MN:
-
Mixes nerves
- PC:
-
Posterior commissure
- PCA:
-
Posterior cerebral artery
- PCli:
-
Posterior clinoid
- PcoA:
-
Posterior communicant artery
- Petr. bone:
-
Petrous bone
- pons:
-
–
- PS:
-
Pituitary stalk
- SP:
-
Septum pellucidum
- Tent.:
-
Tentorium
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Acknowledgment
We gratefully acknowledge Dr LISTRAT Antoine from Clocheville Pediatric Hospital of Tours, Dr SPENNATO Pietro, Dr ALIBERTI Ferdinando, Dr RUGGIERO Claudio and Dr MIRONE Giuseppe from Santobono Children’s Hospital of Naples for their continuous support during production of this chapter by providing operative pictures and for their criticisms and suggestions.
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Lechanoine, F., Cinalli, G. (2018). Hydrocephalus and Arachnoid Cysts. In: Cinalli, G., Ozek, M., Sainte-Rose, C. (eds) Pediatric Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-31889-9_62-1
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