Skip to main content

Advertisement

SpringerLink
Log in

Global trends and decision-making in the management of arachnoid cysts

  • Research
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objective

In pediatric patients, middle cranial fossa (MCF) arachnoid cysts are often discovered incidentally on imaging in asymptomatic patients during workup for other indications. This study aims to describe current management gestalt and threshold for surgical intervention by surveying an international cohort of neurosurgeons.

Methods

A web-based survey was circulated via email list of attendants of the 2019 Canadian Pediatric Neurosurgery Study Group (CPNSG) and International Society of Pediatric Neurosurgery (ISPN) mailing list. The survey consisted of 8 clinical scenarios involving patients with MCF arachnoid cysts. Demographic variables of respondents and their decisions regarding management for each scenario were analyzed using R computing software.

Results

A total of 107 respondents were included. Cysts in asymptomatic patients (92%), younger age at diagnosis (81%), and presence of a mild learning delay were predominantly managed non-surgically (80.7 ± 9.4%). Patients with cyst enlargement, headaches, new seizures, or hemorrhage were divided between non-surgical (55.8 ± 3.3%) and surgical (44.2 ± 2.9%) management. Patients with contralateral hemiparesis were treated predominantly surgically (67%). For both Galassi I and II, papilledema was favored as the primary indication for surgical intervention in 54% of patients. Those inclined to surgery (n = 17) were more likely to practice and train outside North America compared to those not pro-surgical (adjusted P = 0.092).

Conclusion

Incidental MCF arachnoid cysts in asymptomatic patients and younger age of diagnosis are predominantly managed non-surgically. Mild learning delay was not considered an indication to intervene. In contrast, radiological progression, hemorrhagic evolution, or non-focal neurological deficits lead to uncertainty in management, while focal neurological deficits and papilledema with MCF cysts were favored to be intervened surgically. Among the provider level factors, only location of training and practice trended towards a pro-surgery approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

All data and further survey materials is available upon request.

Abbreviations

CPNSG:

Canadian Pediatric Neurosurgery Study Group

CI:

Confidence interval

MCF:

Middle cranial fossa

References

  1. Kalsi P et al (2022) Spinal arachnoid cysts: a case series & systematic review of the literature. Brain Spine 2:100904

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chan JL et al (2021) Paediatric arachnoid cysts: surgical outcomes from a Singapore children’s hospital. J Clin Neurosci 85:122–131

    Article  PubMed  Google Scholar 

  3. Al-Holou WN et al (2010) Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 5(6):578–585

    Article  PubMed  Google Scholar 

  4. Tamburrini G, Dal Fabbro M, Di Rocco C (2008) Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management. Childs Nerv Syst 24(5):593–604

    Article  PubMed  Google Scholar 

  5. Marin-Sanabria EA et al (2007) Evaluation of the management of arachnoid cyst of the posterior fossa in pediatric population: experience over 27 years. Childs Nerv Syst 23(5):535–542

    Article  PubMed  Google Scholar 

  6. Pradilla G, Jallo G (2007) Arachnoid cysts: case series and review of the literature. Neurosurg Focus 22(2):E7

    Article  PubMed  Google Scholar 

  7. Galassi E et al (1982) CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol 17(5):363–369

    Article  CAS  PubMed  Google Scholar 

  8. Helland CA, Wester K (2007) A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry 78(10):1129–1135

    Article  PubMed  PubMed Central  Google Scholar 

  9. Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8(5):281–286

    Article  CAS  PubMed  Google Scholar 

  10. Galassi E et al (1985) Infratentorial arachnoid cysts. J Neurosurg 63(2):210–217

    Article  CAS  PubMed  Google Scholar 

  11. Park YS et al (2009) Neurocognitive and psychological profiles in pediatric arachnoid cyst. Childs Nerv Syst 25(9):1071–1076

    Article  PubMed  Google Scholar 

  12. Maher CO, Goumnerova L (2011) The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts. J Neurosurg Pediatr 7(1):64–72

    Article  PubMed  Google Scholar 

  13. Boutarbouch M et al (2008) Management of intracranial arachnoid cysts: institutional experience with initial 32 cases and review of the literature. Clin Neurol Neurosurg 110(1):1–7

    Article  PubMed  Google Scholar 

  14. Galassi E et al (1988) Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically. Acta Neurochir Suppl (Wien) 42:201–204

    CAS  PubMed  Google Scholar 

  15. Karabagli H, Etus V (2012) Success of pure neuroendoscopic technique in the treatment of Sylvian arachnoid cysts in children. Childs Nerv Syst 28(3):445–452

    Article  PubMed  Google Scholar 

  16. Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6(2):65–70

    MathSciNet  Google Scholar 

  17. Team RC (2022) R: A language and environment for statistical computing. R Foundation for Statistical Computing: Vienna, Austria

  18. Smith-Bindman R et al (2012) Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA 307(22):2400–2409

    Article  CAS  PubMed  Google Scholar 

  19. Kernick D, Campbell J (2009) Measuring the impact of headache in children: a critical review of the literature. Cephalalgia 29(1):3–16

    Article  CAS  PubMed  Google Scholar 

  20. Maher CO, Piatt JH Jr (2015) Incidental findings on brain and spine imaging in children. Pediatrics 135(4):e1084–e1096

    Article  PubMed  Google Scholar 

  21. Jafrani R et al (2019) Intracranial arachnoid cysts: pediatric neurosurgery update. Surg Neurol Int 10:15

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim BS et al (2002) Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 23(10):1674–1677

    PubMed  PubMed Central  Google Scholar 

  23. Huang JH et al (2015) Analysis on clinical characteristics of intracranial Arachnoid Cysts in 488 pediatric cases. Int J Clin Exp Med 8(10):18343–18350

    PubMed  PubMed Central  Google Scholar 

  24. Kang JK et al (2000) Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children. Childs Nerv Syst 16(2):111–116

    Article  CAS  PubMed  Google Scholar 

  25. Bilginer B et al (2009) Arachnoid cyst associated with subdural hematoma: report of three cases and review of the literature. Childs Nerv Syst 25(1):119–124

    Article  PubMed  Google Scholar 

  26. Cress M et al (2013) Risk factors for pediatric arachnoid cyst rupture/hemorrhage: a case-control study. Neurosurgery 72(5):716–22; discussion 722

  27. Cincu R, Agrawal A, Eiras J (2007) Intracranial arachnoid cysts: current concepts and treatment alternatives. Clin Neurol Neurosurg 109(10):837–843

    Article  PubMed  Google Scholar 

  28. Hall S et al (2019) Natural history of intracranial arachnoid cysts. World Neurosurg 126:e1315–e1320

    Article  PubMed  Google Scholar 

  29. Gangemi M et al (2011) Endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid cysts. J Neurosurg Pediatr 8(2):158–164

    Article  PubMed  Google Scholar 

  30. Luan A et al (2021) Are we curing by cutting? A call for long-term follow up and outcomes research in global surgery interventions - perspective. Int J Surg 87:105885

    Article  PubMed  Google Scholar 

  31. Tamburrini G et al (2003) Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst 19(3):159–165

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the gracious support of all the respondents to this survey.

Author information

Authors and Affiliations

  1. Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada

    Pramath Kakodkar

  2. Department of Neurosurgery, University of Ottawa, Ottawa, ON, Canada

    Malavan Ragulojan & Albert Tu

  3. Clinical Research Unit, University of Ottawa, Ottawa, ON, Canada

    Lamia Hayawi & Anne Tsampalieros

  4. Faculty of Science, Western University, London, ON, Canada

    Sharini Sam Chee

  5. School of Medicine, Queens University, Kingston, ON, Canada

    Mia Wu

  6. Department of Neurosurgery, El Paso Children’s Hospital, El Paso, TX, USA

    Ziyad Makoshi

  7. Department of Neurosurgery, Children’s Hospital of British Columbia, Vancouver, BC, Canada

    Ashutosh Singhal & Paul Steinbok

  8. Department of Neurosurgery, University of California LA, Los Angeles, CA, USA

    Aria Fallah

  9. Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA

    Richard A. Robison

  10. Department of Neurosurgery, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Albert Tu

Authors
  1. Pramath Kakodkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malavan Ragulojan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lamia Hayawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne Tsampalieros
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharini Sam Chee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mia Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ziyad Makoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ashutosh Singhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paul Steinbok
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aria Fallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Richard A. Robison
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Albert Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

P.L. and A.T. created the survey for dissemination. P.K. and M.R. wrote the main manuscript text and created Fig. 1. L.W. and A.T. performed statistical analysis and prepared Tables 1–3 and Figs. 2–4 . All authors reviewed the manuscript.

Fig. 4
figure 4

Percentage by prioritization (high (1–2), medium (3–5), low (6–7)) of individually listed symptom that would warrant a surgical intervention in a Galassi I or II cyst. The height of each bar is the sample size of respondents who provided a ranking for each symptom listed on the x-axis. The percentage for each rank color will add up to 100% across all symptoms

Full size image
Table 3 Count and percentage of microsurgery and endoscopic fenestration in pro-surgery and non-pro-surgery group
Full size table

Corresponding author

Correspondence to Malavan Ragulojan.

Ethics declarations

Ethics approval and consent to participate and consent for publication

All data has been deindividuated and made anonymous; thus, consent for publication did not need to be acquired.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Previous presentation

Portion of data previously presented as oral presentation at International Society of Pediatric Neurosurgery 2021. Full data to be presented at International Society of Pediatric Neurosurgery 2023.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 745 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kakodkar, P., Ragulojan, M., Hayawi, L. et al. Global trends and decision-making in the management of arachnoid cysts. Childs Nerv Syst 40, 749–758 (2024). https://doi.org/10.1007/s00381-023-06212-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-023-06212-8

Keywords

Search

Navigation