title: Endoscopic and Microsurgical Treatment of Sylvian Fissure Arachnoid Cysts-Clinical and Radiological Outcome.
abstract: OBJECTIVE
  A Sylvian fissure arachnoid cyst (SAC) is a well-recognized location for an intracranial arachnoid cyst in the pediatric population. For those cysts, which can rupture and be accompanied by a subdural hygroma or hematoma, several treatment modalities have been reported. We report clinical and radiological outcome of fenestration of these cysts by either endoscopy or microsurgery.
  
  
  METHODS
  A retrospective review of the database of operative procedures revealed 24 procedures (20 endoscopic and 4 microsurgical procedures) to fenestrate a SAC at university hospitals in Berlin, Germany and Tokyo, Japan.
  
  
  RESULTS
  With the applied technique, a reduction of SAC volume of more than 10% was achieved in 83.3% of all patients. The median volume of SACs (n = 24) was significantly reduced from 83.5 mL (range 21-509 mL) preoperatively to 45.5 mL (range 8.4-261 mL; P < 0.01) after 3.5 months and to 29.0 mL (range 0-266 mL; P < 0.01) after 15 months. In children (n = 8) with a ruptured SAC the combined extraaxial volume of a SAC and accompanying hygroma/hematoma was reduced from 166 mL (range 111-291 mL) before surgery to 127 mL (range 87-329 mL) after 2 months and to 77 mL (range 25-140 mL; P < 0.05) after 11 months. Acute clinical symptoms were generally resolved postoperatively; headaches were resolved or improved in 75%. A significant association of resolution or improvement of headaches and volume reduction was demonstrated.
  
  
  CONCLUSIONS
  The study demonstrated efficacy in a predominantly endoscopically treated patient cohort with Sylvian fissure arachnoid cysts, as indicated by improvement of clinical symptoms and diminished radiological SAC volume after treatment.
authors.affiliation: Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schulz
authors.affiliation: Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takaoki
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Akiyama
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimoji
authors.affiliation: Division of Pediatric Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Spors
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Miyajima
authors.affiliation: Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany. Electronic address: uthomale@charite.de.
authors.forename: Ulrich-Wilhelm
authors.initials: UW
authors.lastname: Thomale
mesh_terms: D000293:Adolescent; D016080:Arachnoid Cysts / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D008866:Microsurgery; D044583:Neuroendoscopy; D011859:Radiography; D012189:Retrospective Studies; D013702:Temporal Lobe; D016896:Treatment Outcome
keywords: Endoscopic fenestration; Microsurgical fenestration; Sylvian fissure arachnoid cyst