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J Neurol Surg A Cent Eur Neurosurg 2021; 82(01): 043-052
DOI: 10.1055/s-0040-1718522
Original Article

Experience with Management of Intracranial Arachnoid Cysts

Chandrashekhar E. Deopujari
1   Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
,
Salman T. Shaikh
1   Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
,
Vikram S. Karmarkar
1   Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
,
Amol Y. Sudke
2   Department of Neurosciences, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
,
Chandan B. Mohanty
1   Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
,
Naresh K. Biyani
1   Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
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Abstract

Objectives The aim of this study was to analyze the demographics, clinical presentation, and surgical outcome of intracranial arachnoid cysts and to review the surgical options.

Methods This is a retrospective observational study of 56 cases of symptomatic arachnoid cysts among all age groups treated between 2004 and 2020 at the Bombay Hospital, Mumbai. Endoscopic fenestration, microsurgical cyst excision, and shunt insertion were the interventions performed. Clinical presentation, cyst reduction post-intervention, and complications were studied. The follow-up period varied from 1 month to 16 years. Statistical analysis was done for 43 patients with a minimum of 3 years' follow-up.

Results In all, 75% of patients were <18 years of age. Of these, the majority were between the age of 1 and 10 years. There were 14 cases of temporal, 13 cases of retrocerebellar, 10 cases of quadrigeminal cistern, and 7 cases each of interhemispheric and suprasellar arachnoid cysts. The most common clinical presentation was headache and vomiting. Concomitant hydrocephalus was seen on imaging in 24 cases. Endoscopic fenestration of cyst was the most routinely performed procedure (35 cases). Four patients of endoscopic fenestration underwent a redo endoscopic procedure on follow-up. Post-operative reduction in cyst size was found to be significantly better after endoscopic fenestration (p < 0.05).

Conclusion Though the best available treatment for arachnoid cysts remains controversial, surgery has been found to be beneficial in symptomatic cases. Endoscopic fenestration is considered the first-line surgical option and it may be followed by shunt, if necessary. Shunts may be preferred in very young children where there is associated hydrocephalus/macrocephaly.

Keywords

arachnoid cyst - endoscopy - intracranial - shunt

Note

Pediatric data from this paper were presented as - Platform presentation at AASPN March 2017, Mumbai, India. This study is associated with Bombay Hospital Institute of Medical Sciences (BHIMS), Mumbai, India.




Publication History

Received: 10 March 2020

Accepted: 08 June 2020

Article published online:
06 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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