Comparative study on two surgical procedures for middle cranial fossa arachnoid cysts

Abstract

In this study, we explored the operation options for middle cranial fossa arachnoid cysts (MCFAC). One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y (mean=5.4 y). All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration (F) resulted in a more favorable long-term outcome and less complication for cysts of types I and II, whereas a favorable outcome was noted in type III patients who underwent cysto-peritoneal shunting (S). We are led to conclude that Fenestration is suitable for cysts of types I and II (Galassi classification), cysto-peritoneal shunting is better for cysts of type III.

Keywords

arachnoid cyst / middle cranial fossa / fenestration / cysto-peritoneal shunting / follow-up

References

[1] BrightR.. Diseases of the brain and nervous system, 1831, London, Longman Press

[2] ClemneceauS., CarpenterA.. Intracranial arachnoid cyst, A review. Rev Neurol, 1999, 2(6): 604-608

[3] GalassiE., TognettiF., GaistG., et al.. CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol, 1982, 17(3): 363-369

[4] KandenweinJ. A., RichterH. P., BormW.. Surgical therapy of symptomatic arachnoid cysts-an outcome analysis. Acta Neurochir (Wien), 2004, 146(13): 1317-1322

[5] ChoiJ. U., KimD. S.. Pathogenesis of arachnoid cyst: congential or traumatic. Pediatr Neurosurg, 1998, 29(2): 260-266

[6] ShigemoriM., OkuraA., TakahashiY., et al.. New surgical treatment of middle fossa arachnoid cyst. Surg Neurol, 1996, 45(1): 189-192

[7] ElhammadyM. S., BhatiaS., RaghebJ.. Endoscopic fenestration of middle fossa arachnoid cysts: a technical description and case series. Pediatr Neurosurg, 2007, 43(20): 209-215

[8] Di RoccoC., TamburriniG., CaldarelliM., et al.. Prolonged ICP monitoring in Sylvian arachnoid cysts. Surg Neurol, 2003, 60(2): 211-218

[9] SantamartaD., MoralesF., SierraJ.M., et al.. Arachnoid cysts: entrapped collections of cerebrospinal fluid variably communicating with the subarachnoid space. Minim Invasive Neurosurg, 2001, 44(1): 128-134

[10] HoffmannK. T., HostenN., MeyerB. U., et al.. CSF flow studies of intracranial cysts and cyst-like lesions achieved using reversed fast imaging with steady-state precession MR sequences. AJNR Am J Neuroradiol, 2000, 21(4): 493-502

[11] YildizH., ErdoganC., YalcinR., et al.. Evaluation of communication between intracranial arachnoid cysts and cisterns with phase-contrast cine MR imaging. AJNR Am J Neuroradiol, 2005, 26(1): 145-151

[12] KochC. A., VothD., KraemerG., et al.. Arachnoid cysts: does surgery improve epileptic seizures and headaches?. Neurosurg Rev, 1995, 18(1): 173-181

[13] ArroyoS., SantamariaJ.. What is the relationship between arachnoid cysts and seizure foci?. Epilepsia, 1997, 38(10): 1098-1102

[14] AraiH., SatoK., WachiA., et al.. Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery, 1996, 39(11): 1108-1112

[15] KochC. A., MooreJ. L., VothD.. Arachnoid cysts: how do postsurgical cyst size and seizure outcome correlate?. Neurosurg Rev, 1998, 21(1): 14-22

[16] RaffelC., McCombJ.G.. To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?. Neurosurgery, 1988, 23(3): 338-342

[17] LudersH. O.. Epilepsy Surgery, 1992, New York, Kaven Press: 268