title: Operative management of idiopathic spinal intradural arachnoid cysts in children: a systematic review.
abstract: BACKGROUND
  Spinal intradural arachnoid cysts are rare with only a few patients reported so far. Idiopathic, traumatic, posthemorrhagic, and postinflammatory causes have been reported in the literature. Especially, idiopathic lesions, in which other possible etiological factors have been ruled out, seem to be rare.
  
  
  METHODS
  We systematically reviewed the literature in regards to localization within the spinal canal, treatment options, complications, and outcome. Additionally, we present management strategies in two progressively symptomatic children less than 3 years of age with idiopathic intradural arachnoid cysts.
  
  
  RESULTS
  In total, 21 pediatric cases including the presented cases have been analyzed. Anterior idiopathic spinal arachnoid cysts are predominantly located in the cervical spine in 87.5 % of all cases, whereas posterior cysts can be found at thoracic and thoracolumbar segments in 84.6 % of the patients. Most children presented with motor deficits (76.2 %). Twenty-five percent of anterior spinal arachnoid cysts caused back pain as the only presenting symptom. Open fenestration by a dorsal approach has been used in the vast majority of cases. No major surgical complications have been reported. Ninety-four percent of all patients did improve or showed no neurological deficits. Recurrence rate after successful surgical treatment was low (9.5 %).
  
  
  CONCLUSIONS
  Idiopathic spinal intradural arachnoid cysts can present with neurological deficits in children. Pathologies are predominantly located in the cervical spine anteriorly and in thoracic and thoracolumbar segments posteriorly to the spinal cord. In symptomatic cases, microsurgical excision and cyst wall fenestration via laminotomy are recommended. Our radiological, intraoperative, and pathological findings support the cerebrospinal fluid obstruction and vent mechanism theory of arachnoid cysts.
authors.affiliation: Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Petros
authors.initials: P
authors.lastname: Evangelou
authors.forename: Jürgen
authors.initials: J
authors.lastname: Meixensberger
authors.forename: Matthias
authors.initials: M
authors.lastname: Bernhard
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hirsch
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.forename: Andreas
authors.initials: A
authors.lastname: Merkenschlager
authors.forename: Ulf
authors.initials: U
authors.lastname: Nestler
authors.forename: Matthias
authors.initials: M
authors.lastname: Preuss
mesh_terms: D016080:Arachnoid Cysts / Q000150:complications / Q000601:surgery*; D002648:Child; D006801:Humans; D007796:Laminectomy; D013116:Spinal Cord / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome