Аннотация:OBJECTIVE:To outline surgical treatment of uncommon hemispheric
CSF containing cysts in children.
MATERIAL-METHODS:152 pediatric patients had primary neurosurgical
operations for intracranial CSF cysts in our department from 2013 till 2018.
After exclusion of sylvian fissure, midline supratentorial and posterior fossa
cysts we found 29 patients (19%) with hemispheric CSF cysts for this report.
Medical records, imaging data and intraoperative videos were reviewed; families were interviewed in 2019 to gather outcome data.
RESULTS:There were 13(45%) lateral ventricle cysts (LVC),
9(31%) interhemispheric fissure cysts (IHFC) and 7(24%) cysts
in and around frontal lobe (FLC). Median age at surgery was 2
years (1m-17y). M/F ratio was 21/8. There were 16(55%) arachnoid,
7(24%) choroid plexus, 4(14%) ependymal and 2(7%) parenchymal
cysts. Decisive surgical indications were cyst enlargement in 10(34%)
Intracranial hypertension in 9(31%), neurologic deficits in 6(21%); headache
in 3(10%), epilepsy in 1(3%). Cyst fenestration was a primary treatment
modality in all cases. It was accomplished endoscopically in 17(59%) and
microsurgically in 12(41%) patients. In 4 cases stents were used to support
unreliable communications. ETV was done simultaneously in 3
patients.Complications occurred in 2 patients (7%) including hemiparesis
and intraventricular hemorrhage.Median follow up was 18 months (range
4m-6y; available for 27 of patients (93%)). Redo fenestration was necessary
in 1(4%) patient; in 26 patients communications were preserved with cyst
reduction. In 4 patients (15%) persistent hydrocephalus required shunt
surgery. At last follow up 14(52%) patients developed normally without
symptoms; 11(41%) had some symptoms with improvement compared to
preoperative state (4 of them shunt-dependent); 1 patient (4%) experienced no
improvement of preoperative symptomatology and 1(4%) deteriorated due to
complication.
CONCLUSION:Fenestration allows effective management of hemispheric
CSF containing cysts with 15% CSF shunt dependency rate. Complication
rate is not insignificant and need to be considered in patients with asymptomatic cyst enlargement.