Pediatrik orta kraniyal fossa araknoid kistlerde uygulanan şant cerrahisinin etkinliği

Year 2023, Volume: 28 Issue: 3, 297 - 302, 28.09.2023

Özgür Demir

https://doi.org/10.21673/anadoluklin.1253550

Abstract

Amaç: Araknoid kistlerin yarıdan fazlası orta fossa yerleşimlidir. Literatürde tedavi zamanlaması ve şekli konusunda tam bir görüş birliği bulunmamaktadır. Biz kliniğimizde orta kraniyal fossa araknoid kistlerde şant cerrahisi uyguladığımız hastaların sonuçlarını sunarak bu hastaların tedavileri konusuna katkıda bulunmayı amaçladık.

Yöntemler: 2015 ve 2021 yılları arasında kliniğimizde orta kranial fossada tip 3 araknoid kist nedeniyle kistoperitoneal şant cerrahisi uyguladığımız 6 hastayı retrospektif olarak inceledik. Tüm hastaların operasyon öncesi ve sonrası klinik ve radyoljik durumları incelenerek not edildi. Operasyon sonrası 1. yıl klinik ve radyolojik kontrolleri de mevcut olan hastalar çalışmaya dâhil edildi.

Bulgular: Tüm hastaların araknoid kist yerleşim yeri kranial orta fossa idi ve tüm hastalar kistoperitoneal şant ile tedavi edildiler. 2 yaş altı tüm hastalarda tespit edilmiş şikayet veya bulgu hareket ve tepkilerde azalma ve fontonel gerginliği iken 2 yaş üstünde şiddetli baş ağrısıydı. Tüm hastaların araknoid kistleri sınıflandırmada tip 3’tü ve radyolojik incelemelerde bası bulguları vardı. Hastaların tümünün cerrahi sonrası semptom ve şikayetleri azaldı. Bir hastada slit kist sendromunu düşündürecek klinik bulgular oluştu. Bu hasta dışında hiçbir hastada kontrol süresince herhangi bir komplikasyon görülmedi.

Sonuç: Çalışmamız pediatrik orta kraniyal fossa tip 3 araknoid kistli hastalarda kistoperitoneal şant cerrahisinin, ilk tedavi yöntemi olarak da uygulanabilecek etkili ve güvenli tedavi yöntemi olduğu görüşünü desteklemektedir.

Keywords

Araknoid kistler, beyin omurilik sıvısı şantları, kraniotomi

Efficacy of shunt surgery in pediatric middle cranial fossa arachnoid cysts

Abstract

Aim: More than half of arachnoid cysts are located in the middle fossa. There is no consensus in the literature on the timing and type of treatment. We aimed to contribute to the treatment of these patients by presenting the results of patients who underwent shunt surgery in middle cranial fossa arachnoid cysts in our clinic.

Methods: We retrospectively reviewed 6 patients who underwent cystoperitoneal shunt surgery for type 3 arachnoid cysts in the middle cranial fossa between 2015 and 2021 in our clinic. The clinical and radiological conditions of all patients before and after the operation were examined and noted. Patients who had postoperative 1st year clinical and radiological controls were included.

Results: The arachnoid cyst location of all patients was cranial middle fossa and all patients were treated with cystoperitoneal shunt. The complaint or finding detected in all patients under 2 years of age was fontonal tension and decrease in movement and reactions, while severe headache over 2 years of age. The arachnoid cysts of all patients were type 3 in classification and there were compression findings in radiological examinations. Postoperative symptoms and complaints of all patients decreased. Clinical findings suggestive of slit cyst syndrome occurred in one patient. Except for this patient, no complications were observed during the control period in any of the patients.

Conclusion: Our study supports the view that cystoperitoneal shunt surgery is an effective and safe treatment method that can also be applied as the first treatment method in pediatric middle cranial fossa type 3 arachnoid cysts.

Keywords

Arachnoid cysts, craniotomy, cerebrospinal fluid shunts

References

• Pradilla G, Jallo G. Arachnoid cysts: case series and review of the literature. Neurosurg Focus. 2007;22(2):E7.
• Cincu R, Agrawal A, Eiras J. Intracranial arachnoid cysts: current concepts and treatment alternatives. Clin Neurol Neurosurg. 2007;109(10):837-43.
• Harsh GR 4th, Edwards MS, Wilson CB. Intracranial arachnoid cysts in children. J Neurosurg. 1986;64(6):835-42.
• Ali ZS, Lang SS, Bakar D, Storm PB, Stein SC. Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options. Childs Nerv Syst. 2014;30(3):461-69.
• Gosalakkal JA. Intracranial arachnoid cysts in children: a review of pathogenesis, clinical features, and management. Pediatr Neurol. 2002;26(2):93-8.
• Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr. 2010;5(6):578-85.
• Ali ZS, Lang SS, Bakar D, Storm PB, Stein SC. Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options. Childs Nerv Syst. 2014;30(3):461-69.
• Alexiou GA, Varela M, Sfakianos G, Prodromou N. Shunting for the treatment of arachnoid cysts in children. Neurosurgery. 2010;67(6):1632-6.
• Raffel C, McComb JG. To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients? Neurosurgery. 1998;23(3):338-42.
• Shim KW, Lee YH, Park EK, Park YS, Choi JU, Kim DS. Treatment option for arachnoid cysts. Childs Nerv Syst. 2009;25(11):1459-66.
• Helland CA, Wester K. A population-based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in children. J Neurosurg. 2006;105(5 Suppl):385-90.
• Kandenwein JA, Richter HP, Börm W. Surgical therapy of symptomatic arachnoid cysts - an outcome analysis. Acta Neurochir (Wien). 2004;146(12):1317-22.
• Boutarbouch M, El Ouahabi A, Rifi L, Arkha Y, Derraz S, El Khamlichi A. Management of intracranial arachnoid cysts: institutional experience with initial 32 cases and review of the literature. Clin Neurol Neurosurg. 2008;110(1):1-7.
• Chen Y, Fang HJ, Li ZF, et al. Treatment of middle cranial fossa arachnoid cysts: a systematic review and meta-analysis. World Neurosurg. 2016; 92(2):480-90.
• Halani SH, Safain MG, Heilman CB. Arachnoid cyst slit valves: The mechanism for arachnoid cyst enlargement. J Neurosurg Pediatrics. 2013;12(1):62-6.
• Duz B, Kaya S, Daneyemez M, Gonul E. Surgical Management strategies of intracranial arachnoid cysts: A single institution experience of 75 cases. Turkish Neurosurg. 2012;22(5):591-8.
• Rizk E, Chern JJ, Tagayun C, et al. Institutional experience of endoscopic suprasellar arachnoid cyst fenestration. Childs Nerv Syst. 2013;29(8):1345-7.
• Karabagli H, Etus V. Success of pure neuroendoscopic technique in thetreatment of Sylvian arachnoid cysts in children. Childs Nerv Syst. 2012;28(3):445-52.
• Di Rocco F, R James S, Roujeau T, et al. Limits of endoscopic treatment of sylvian arachnoid cysts in children. Childs Nerv Syst. 2010;26(1):155-62.
• Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor forchronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma. 2002;19(9):1017-27.
• Cinalli G, Spennato P, Ruggiero C, et al. Complications following endoscopic intracranial procedures in children. Childs Nerv Syst. 2007;23(8):633-44.
• 22. Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C. Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst. 2003;19(3):159-65.
• Ciricillo SF, Cogen PH, Harsh GR, Edwards MS. Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting. J Neurosurg. 1991;74(2):230-5.
• Sunami K, Saeki N, Sunada S, et al. Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children--a clinical entity difficult to detect on neuroimaging study. Brain Dev. 2002;24(8):776-9.