Comparing Surgical Treatment Options for Intracranial Arachnoid Cysts; Radiological, Clinical and Histopathological Outcomes of the Operated Patients

Abstract

Aim: This study was designed to examine patients who underwent surgery for arachnoid cysts and compare surgical treatment options in terms of clinical, radiological and histopathological outcomes. Methods: Data obtained from 47 patients who underwent surgery for arachnoid cysts at 3 neurosurgery institutions between November 2002 and January 2020 were retrospectively reviewed. As the surgical interventions, two methods were performed; cyst fenestration with craniotomy, and cystoperitoneal shunt. Results: The mean age of the patients was 12.7 ± 11.3 years. Among them, 18 (38.3%) were female and 29 (61.7%) were male. 40 were pediatric and 7 were adult patients. In the study group, 32 patients (68%) underwent fenestration with craniotomy, while 15 patients (32%) underwent cystoperitoneal shunt application. The mean reduction rates of the cyst volume were determined as 51.4%. When comparing the surgeries performed, no statistically significant difference was found between the reduction rates (p>0.05). The group with the highest reduction rates was detected as convexity cysts treated with fenestration with a rate of 73.9%. In the postoperative period, the symptoms of 29 patients (62%) completely resolved, while the symptoms of 14 patients (30%) improved. Symptoms did not change in 3 patients (6%), and worsening was observed in 1 patient (2%). When comparing the surgeries performed, the rate of complete resolution of symptoms was found to be statistically significantly higher in the fenestration group (p=0.01). Postoperative cyst volumes were found higher in the patients with edema positivity (p=0.031) and thickening of basal lamina negativity (p=0.046). Preoperative mass effect was found statistically significant in the patients with edema positivity (p=0.006) and thickening of basal lamina negativity (p=0.013). Postoperative mass effect reduction was also found statistically significant in the patients with edema positivity (p=0.024) and thickening of basal lamina negativity (p=0.002). Conclusions: The present study revealed that fenestration with craniotomy seems to be a favorable technique as the first step in the treatment of arachnoid cysts. The rate of complete resolution of symptoms was higher in the fenestration group and complication rates were higher in the cystoperitoneal shunt group. However, we think that the patients with coexistence of arachnoid cyst and hydrocephalus should be treated with cystoperitoneal shunt application. We also found that the membrane thickness of arachnoid cysts and the amount of collagen increases as the patients’ age increases and tissue edema increases in younger patients. Preoperative mass effect, and postoperative reduction in mass effect correlated positively with tissue edema and negatively with basal lamina thickness.

Keywords

• Arachnoid cyst
• fenestration
• cystoperitoneal shunt
• hydrocephalus
• histopathology

İntrakranial Araknoid Kistlerde Cerrahi Tedavi Seçeneklerinin Karşılaştırılması; Ameliyat Edilen Hastaların Radyolojik, Klinik ve Histopatolojik Sonuçları

Öz

Giriş: Bu çalışma, araknoid kist nedeniyle cerrahi uygulanan hastaları incelemek ve cerrahi tedavi seçeneklerini klinik, radyolojik ve histopatolojik sonuçlar açısından karşılaştırmak amacıyla tasarlanmıştır. Gereç ve Yöntemler: Kasım 2002 ile Ocak 2020 tarihleri arasında 3 nöroşirürji merkezinde araknoid kist nedeniyle cerrahi uygulanan 47 hastanın verileri retrospektif olarak incelendi. Cerrahi girişim olarak kraniotomi ile kist fenestrasyonu ve kistoperitoneal şant olmak üzere iki yöntem uygulandı. Sonuç: Hastaların yaş ortalaması 12,7 ± 11,3 yıldı. Bunlardan 18’i (%38,3) kadın, 29’u (%61,7) erkekti. 40’ı pediatrik, 7’si erişkin hastaydı. Çalışma grubunda 32 hastaya (%68) kraniotomi ile fenestrasyon uygulanırken, 15 hastaya (%32) kistoperitoneal şant uygulandı. Kist hacmindeki ortalama küçülme oranları %51,4 olarak belirlendi. Yapılan ameliyatlar karşılaştırıldığında küçülme oranları arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). En yüksek küçülme oranına sahip grup %73,9 oranında fenestrasyon ile tedavi edilen konveksite kistleri olarak saptandı. Ameliyat sonrası dönemde 29 hastanın (%62) semptomları tamamen düzelirken, 14 hastanın (%30) semptomlarında iyileşme görüldü. Semptomlar 3 hastada (%6) değişmezken, 1 hastada (%2) kötüleşme görüldü. Yapılan cerrahiler karşılaştırıldığında, fenestrasyon grubunda semptomların tamamen düzelme oranı istatistiksel olarak anlamlı düzeyde daha yüksek bulundu (p=0,01). Ödem pozitifliği (p=0,031) ve bazal lamina kalınlaşması negatifliği (p=0,046) olan hastalarda postoperatif kist hacimleri daha yüksek bulundu. Ödem pozitifliği (p=0,006) ve bazal lamina kalınlaşması negatifliği (p=0,013) olan hastalarda preoperatif kitle etkisi istatistiksel olarak anlamlı bulundu. Ödem pozitifliği (p=0,024) ve bazal lamina kalınlaşması negatifliği (p=0,002) olan hastalarda postoperatif kitle etkisi azalması da istatistiksel olarak anlamlı bulundu (p=0,002). Tartışma: Çalışmamızda kraniotomi ile fenestrasyonu araknoid kistlerin tedavisinde ilk basamak olarak olumlu bir teknik olarak görünmektedir. Fenestrasyon grubunda semptomların tam olarak düzelme oranı daha yüksek, kistoperitoneal şant grubunda ise komplikasyon oranları daha yüksek bulunmuştur. Ancak araknoid kist ve hidrosefali birlikteliği olan hastaların kistoperitoneal şant uygulaması ile tedavi edilmesi gerektiğini düşünmekteyiz. Ayrıca araknoid kistlerin membran kalınlığının ve kollajen miktarının hastaların yaşı arttıkça arttığını ve genç hastalarda doku ödeminin arttığını saptadık. Ameliyat öncesi kitle etkisi ve ameliyat sonrası kitle etkisindeki azalmanın doku ödemi ile pozitif, bazal lamina kalınlığı ile negatif korelasyon gösterdiği görüldü.

Anahtar Kelimeler

• Araknoid kist
• fenestrasyon
• kistoperitoneal şant
• hidrosefali
• histopatoloji

Kaynakça

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