Considerations in Treating Neonatal and Infantile Patients with a Retrocerebellar Arachnoid Cyst: in the Perspective of Different CSF Dynamics
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Arachnoid cysts found under the age of 1 year are more likely to grow in size, relatively short term follow-up is required. Retrocerebellar location predicts a high risk of hydrocephalus, and the time window until irreversible neuronal damage is often narrow if the arachnoid cyst increases in size and becomes symptomatic. However, when and how to treat a neonatal or infantile patient with a retrocerebellar arachnoid cyst is still a controversial subject. We recently experienced 3 differently treated very young pediatric patients with retrocerebellar arachnoid cysts. One patient was treated two weeks after birth by a cystoperitoneal shunt. This patient showed normal development after the surgery. The other patient was treated by a ventriculoperitoneal shunt and subsequent cystoventriculostomy at the age of 4 months because of his mother’s refusal on 14th day after birth. This one showed developmental delay despite of decreasing size of ventricles after the surgery. The last patient was treated with microscopic fenestration, which failed in its initial attempt. A revision operation by cyst excision succeeded and had no problem after the surgery. Therefore, we suggest that early surgical intervention for retrocerebellar arachnoid cyst can be considered. Although there are concerns of long term complications related to shunts, a cystoperitoneal shunt would be a feasible treatment if we consider the minor cerebrospinal fluid pathway which is the dominant cerebrospinal fluid dynamic at this age.
Abstract
Arachnoid cysts found under the age of 1 year are more likely to grow in size, relatively short term follow-up is required. Retrocerebellar location predicts a high risk of hydrocephalus, and the time window until irreversible neuronal damage is often narrow if the arachnoid cyst increases in size and becomes symptomatic. However, when and how to treat a neonatal or infantile patient with a retrocerebellar arachnoid cyst is still a controversial subject. We recently experienced 3 differently treated very young pediatric patients with retrocerebellar arachnoid cysts. One patient was treated two weeks after birth by a cystoperitoneal shunt. This patient showed normal development after the surgery. The other patient was treated by a ventriculoperitoneal shunt and subsequent cystoventriculostomy at the age of 4 months because of his mother’s refusal on 14th day after birth. This one showed developmental delay despite of decreasing size of ventricles after the surgery. The last patient was treated with microscopic fenestration, which failed in its initial attempt. A revision operation by cyst excision succeeded and had no problem after the surgery. Therefore, we suggest that early surgical intervention for retrocerebellar arachnoid cyst can be considered. Although there are concerns of long term complications related to shunts, a cystoperitoneal shunt would be a feasible treatment if we consider the minor cerebrospinal fluid pathway which is the dominant cerebrospinal fluid dynamic at this age.
참고문헌 (20)
- Al-Holou WN, "Prevalence and natural history of arachnoid cysts in children", J Neurosurg Pediatr, 5, pp.578~585 (2010)
- Al-Holou WN, "Prevalence and natural history of arachnoid cysts in adults", J Neurosurg, 118, pp.222~231 (2013)
- King JA, "Ventriculocystostomy and endoscopic third ventriculostomy", shunt placement in the management of hydrocephalus secondary to giant retrocerebellar cysts in infancy, 2010, pp.5, 403~407
- Turner MS, "A novel method for stereotactic, endoscope-assisted transtentorial placement of a shunt catheter into symptomatic posterior fossa cysts", J Neurosurg Pediatr, 8, pp.15~21 (2011)
- Ali ZS, "Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options", Childs Nerv Syst, 30, pp.461~469 (2014)
- Nowosławska E, "Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods", Childs Nerv Syst, 22, pp.599~604 (2006)
- Oi S, "Proposal of"evolution theory in cerebrospinal fluid dynamics"and minor pathway hydrocephalus in developing immature brain", Childs Nerv Syst, 22, pp.662~669 (2006)
- Lee JY, "Enlarging arachnoid cyst: a false alarm for infants.", Childs Nerv Syst, 28, pp.1203~1211 (2012)
- Fewel ME, "Surgical treatment of 95children with 102 intracranial arachnoid cysts", Pediatr Neurosurg, 25, pp.165~173 (1996)
- Ciricillo SF, "Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting", J Neurosurg, 74, pp.230~235 (1991)
- Tamburrini G, "Sylvian fissure arachnoid cysts : a survey on their diagnostic workout and practical management", Childs Nerv Syst, 24, pp.593~604 (2008)
- Arai H, "Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting", Neurosurgery, 39, pp.1108~1112 (1996)
- Zada G, "Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age", Neurosurg Focus, 22, pp.E1~ (2007)
- Kim S, "Shunt dependency in shunted arachnoid cyst : a reason to avoid shunting", Pediatr Neurosurg, 37, pp.178~185 (2002)
- Sacko O, "Endoscopic third ventriculostomy : outcome analysis in 368procedures", J Neurosurg Pediatr, 5, pp.68~74 (2010)
- Koch D, "Endoscopic third ventriculostomy in infants of less than 1 year of age: which factors influence the outcome?", Childs Nerv Syst, 20, pp.405~411 (2004)
- Lee S, "Comparison of clinical and radiological manifestations and surgical outcomes of pediatric Chiari I malformations in different age groups", Childs Nerv Syst, 31, pp.2091~2101 (2015)
- Mattei TA, "Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts", J Neurosurg Pediatr, 12, pp.555~564 (2013)
- Mattei TA, "Clinical outcomes of temporary shunting for infants with cerebral pseudomeningocele", Childs Nerv Syst, 30, pp.283~291 (2014)
- Martínez-Lage JF, "Hydrocephalus and arachnoid cysts", Childs Nerv Syst, 27, pp.1643~1652 (2011)