Neuropediatrics 2006; 37 - THP125
DOI: 10.1055/s-2006-945948

NEUROENDOSCOPIC TREATMENT OF ARACHNOIDAL CYSTS IN CHILDREN

Z Novák 1, J Chrastina 1, P Krupa 1, E Lžičařová 1, I Øíha 1
  • 1Neurosurgical Clinic, Faculty Hospital St. Ann's, Brno, Brno, Czech Republic

Objective: The aim of the paper is to present the experience of a tertiary referral center with the treatment of paediatric patients with arachnoidal cysts. Minimal invasiveness of the endoscopic approach to the pathology is further potentiated by stereotactic frame or neuronavigation systems. The surgical philosophy together with the analysis of clinical outcomes with attention paid to epilepsy is analysed.

Methods: Out of 400 patients, treated by means of navigated neuroendoscopy for the most diverse pathologies, there were 61 arachnoidal cysts. 9 of them were found in children (age less than 18 years) –6 boys, 3 girls, average age 11.6 years. Clinical presentation was heralded by epilepsy in 5 cases, headaches in 3 patients and mental retardation with double vision in one case. The cyst location was middle fossa in 5 cases (size Gallasi II– III), posterior fossa in 3 cases and frontal in 1 case. In 2 patients various drainage systems were implanted before endoscopic surgery. Cystocisternostomy was done in 6 patients, cystoventriculostomy in 2 patients, fenestration of cyst septa and shunt insertion under endoscopic control in 1 patient. Rigid endoscopic system Wolf was used in the majority of cases. Stereotactic ceramic frame Leibinger, fully MRI compatible with ZamoranoDujovny and navigation system BrainLab VectorVision Sky were used according to surgeon 's decision.

Results: There were no surgical complications requiring conversion into open surgery. In one patients no site for cystocisternostomy was found due to basal cisterns tightness. In one patient after previous shunting it was possible to remove the device. Epileptic seizures were controlled in 4 cases, the remaining patient is planned for further epileptosurgical evaluation.

Conclusion: Navigated neuroendoscopy is safe and efficient treatment mode for patients with arachnoidal cysts. Relieve of seizures is a more complex problem requiring detailed evaluation, especially in the case of pharmacoresistancy.