The clinical classification and treatment of middle cranial fossa arachnoid cysts in children.
OBJECTIVE
The optimal management for middle fossa arachnoid cysts (MFAC) remains controversial, but cystocistern fenestration is effective. MFACs are divided into non-communicating arachnoid cysts (NCIAC) and communicating arachnoid cysts (CIAC). This retrospective observational study evaluated the role of phase-contrast cine magnetic resonance imaging (PC-MRI) in the diagnosis and postoperative evaluation of MFACs and assessed surgical outcomes.


METHODS
Twenty-eight children with MFAC that were diagnosed by conventional neuroradiology were enrolled. PC-MRI was performed preoperatively. The clinical manifestations, cyst volumes and PC-MRI data were analyzed, and the flow of cerebrospinal fluid (CSF) at the fistula was qualitatively evaluated.


RESULTS
No communication with the adjacent subarachnoid space was found on preoperative PC-MRI in 20 patients, and they were diagnosed with NCIAC. A statistically significant decrease in cyst volume was observed in all 20 patients postoperatively. Symptoms resolved or improved in the 14 patients who were symptomatic preoperatively, and a positive CSF flow was found in all 20 patients postoperatively. PC-MRI diagnosed eight patients with CIAC, and the cyst sizes did not increase during follow-up.


CONCLUSIONS
Cystocistern fenestration is an effective treatment for children with lateral fissure IAC. PC-MRI can be used to determine the IAC type and to evaluate the effectiveness of cystocistern fenestration.
Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing, China.
Lusheng
L
Li
Yuting
Y
Zhang
Yingliang
Y
Li
Xuan
X
Zhai
Yudong
Y
Zhou
Ping
P
Liang
D000293:Adolescent; D000465:Algorithms; D016080:Arachnoid Cysts / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D035301:Cranial Fossa, Middle / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013353:Subdural Effusion / Q000209:etiology; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology