Паёми Сино (Sep 2020)
ENDOSCOPIC TREATMENT OF ARACHNOID CYSTS OF THE MIDDLE CRANIAL FOSSA IN CHILDREN
Abstract
Objective: Improvement of the results and effectiveness of endoscopic treatment for arachnoid cysts of the middle cranial fossa (AC MCF) in children. Methods: At the Federal Center for Neurosurgery of Tyumen 65 patients with AC MCF were operated from 2012 to 2018 by endoscopic cystocisternostomy (ECCS). Patients age ranged from one month up to 17 years. Children under 3 years old were – 32 (49%). Hypertensive symptoms were in 26 (40%); delayed speech development in 20 (31%); symptomatic epilepsy in 12 (18.5%); pathology of the ocular fundus was in 5 (7.7%). Associated abnormalities were in 19 (29%). All patients underwent CT and/or MRI. In 46 (71%) patients, cysts were located on the right, in 13 (20%) on the left and 6 (9%) bilateral. The displacement of the middle structures was diagnosed in 45 (69%). According to the Galassi classification: type II was in 20 (31%), type III – in 45 (69%) patients. The average volume of AC MCF before the operation was 181±18.6 cm3. All 65 patients underwent ECCS: a miniature neuroendoscope KarlStorz – Endoskop 11576 KF/KG was used in 47 patients, and a standard rigid endoscope LOTTA, «Gaab I scope» or flexible video scope was used in 18 patients. Results: The postoperative observation period ranged from 1 year to 8 years. The volume of cysts after surgery averaged 124.8±17.2 cm3. On average, the volume of cysts decreased by 58.2±13.5 cm3. The total efficiency of ECCS in 65 patients with AC MCF reached 81.5% of cases. Relapse was noted in 14 patients (22%). The period of recurrence ranged from 1 month to 81 month. Recurrence was in 71% of children under the age of 3 years. There was a correlation between repeated interventions and age. Children under 3 years of age have the efficiency of surgical treatment at 68.8% than in children over 3 years old – 93.8% (p≤0.01). The results of surgical treatment, depending on the endoscope used, were statistically unreliable, because when using Karl Storz – Endoskop 11576 KF/KG the total efficiency was 81%, and when using LOTTA, «Gaab I scope» or a flexible video scope – 84%. Complications in the postoperative period occurred in 6 (9%) children. Conclusion: The effectiveness of ECCS in 65 children with AC MCF reached 81.5% of cases. The effectiveness of ECCS in children under 3 years of age was 68.7%, and 93.7% in children older than 3 years.
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