The Study On Surgical Treatment Of Children Intracranial Arachnoid Cysts

Objective We analyzed retrospectively those patients under 14 years old with intracranial arachnoid cysts since 2006 in Children's Hospital Affiliated to Chongqing Medical University.Follow up the treatment and prognosis,to evaluate outcomes of four surgical approaches(open craniotomy for cyst excision,endoscopic cyst fenestration,and cystoperitoneal shunting)for the intracranial arachnoid cysts of different locations in children.Methods 144 subjects was included in the study,retrospective analyze the follow-up data such as images and clinical finding of the patients younger than 14 years old in our department since 2006,and compare the successful rate and complication rate.Among 144 patients the cyst location was middle fossa in 59(microsurgical fenestration16 and endoscopic fenestration in 23,cystoperitoneal shunting in17,excision by craniotomy3),sylvian region in 41(endoscopic fenestration in 11,cyst shunting in 23,microsurgical excision by craniotomy7),posterior fossa in 28(endoscopic fenestration in6,cyst shunting in18,microsurgical excision by craniotomy4).suprasellar in 11 cases(endoscopic fenestration in11),quadrigeminal in 5(endoscopic fenestration in2,cyst shunting in3).Result The success rate(complete or partial clinical remission)and(the reduction of the cyst)in the authors' cystocisternostomy series in middle fossa was 85% and 89%,the early complication rate was 51%,the late complication rate was10%,the complications need surgery procedure was12%;The success rate(complete or partial clinical remission)and(the reduction of the cyst)in the authors' series cyst shunting in middle fossa was 75% and 70%,the early complication rate was 5%,the late complication rate was47%,all the complications need surgery procedure,the volume of the 3cases excision by craniotomy was significantly,and all were complete or partial clinical remission.In sylvian region the success rate(complete or partial clinical remission)and(the reduction of the cyst)in the authors' cystocisternostomy series was 77% and 81%,the early complication rate was 63%,there was no late complication,no complications need surgery procedure;The success rate(complete or partial clinical remission)and(the reduction of the cyst)in the authors' series cyst shunting was 88% and 91%,there was no early complication rate,the late complication rate was 52%,all the complications need surgery procedure;the success rate(complete or partial clinical remission)in the authors' excision by craniotomy series was 75%,the early complication rate was 14%,there was no late complication.In posterior cranial fossa the success rate(the reduction of the cyst)in the authors' cystocisternostomy series was 83%,all patients were complete or partial clinical remission,the early complication rate was 16%,there was no late complication,no complications need surgery procedure.The success rate(complete or partial clinical remission)and(the reduction of the cyst)in the authors' series cyst shunting was 94% and 94%,there was no early complication rate,the late complication rate was 22%,all the complications need surgery procedure,the reduction of the cyst in the authors' excision by craniotomy series was 75%.In suprasellar the reduction of the cyst in the authors' cystocisternostomy series was 90%.In quadrigeminal the reduction of the cyst in the authors' cystocisternostomy series,the volume of the 2cases in the authors' cystocisternostomy series was significantly,and all were complete reducted.Conclusion(1)For pediatric middle fossa,sylvian region,posterior cranial fossa,suprasellar and quadrigeminal arachnoid cysts,endoscopic fenestration should be the initial surgical procedure;(2)For middle fossa and sylvian region microsurgical fenestration should be the second choice;(3)For posterior cranial fossa cysts,cystoperitoneal shunting is the second choice,and excision by craniotomy usually should not be considered;(4)For suprasellar cysts ventriculocystocisternostomy should be the initial surgical procedure;(5)For quadrigeminal,VC together with ETV is an effective treatment and should be the initial surgical procedure.