Long-term outcome of large sylvian arachnoid cysts: the role of surgery has been exaggerated

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  • 1 Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul;
  • 2 Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul; and
  • 3 Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea
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OBJECTIVE

The surgical indications for some arachnoid cysts (ACs) are controversial. While surgical procedures can be effective when an AC is a definite cause of hydrocephalus or papilledema, most ACs do not cause any symptoms or signs. Some surgeons perform several procedures to treat ACs because of their large size. The purpose of this study was to compare the long-term outcomes of Galassi type III ACs between surgery and nonsurgery groups.

METHODS

The medical records of 60 patients diagnosed with sylvian ACs (Galassi type III) who visited Seoul National University Children’s Hospital from July 1990 to March 2018 were analyzed. The authors compared the outcomes between those treated with surgery and those not treated with surgery.

RESULTS

Of the 60 patients, 27 patients had no symptoms, 19 patients had vague symptoms and signs associated with ACs, and the remaining 14 patients had definite AC-related symptoms and signs. Thirty-eight patients underwent surgery, and 22 patients underwent observation. Some operations were accompanied by complications. Among the 33 patients in the surgery group, excluding 5 with hydrocephalus or papilledema, 8 patients needed 18 additional operations. However, there were no patients in the nonsurgery group who needed surgical intervention during the follow-up period (mean 67.5 months), although the size of the AC increased in 2 patients. Changes in AC size were not correlated with symptom relief.

CONCLUSIONS

When patients with hydrocephalus or papilledema were excluded, there was no difference in the outcomes between the surgery and nonsurgery groups regardless of the size of the sylvian AC. Surgeons should be cautious when deciding whether to operate.

ABBREVIATIONS AC = arachnoid cyst; CP = cystoperitoneal; ICP = intracranial pressure; SDFC = subdural fluid collection; SDH = subdural hematoma.

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Contributor Notes

Correspondence Kyu-Chang Wang: Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. kcwang@snu.ac.kr.

INCLUDE WHEN CITING Published online May 15, 2020; DOI: 10.3171/2020.3.PEDS19574.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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