Free CME Article: Risk Factors for Pediatric Arachnoid Cyst Rupture/Hemorrhage

Background: As the availability of imaging modalities has increased, the finding of arachnoid cysts has become common. Accurate patient counseling regarding physical activity or risk factors for cyst rupture or hemorrhage has been hampered by the lack of definitive association studies.

Objective: This case-control study evaluated factors that are associated with arachnoid cyst rupture (intracystic hemorrhage, adjacent subdural hematoma, or adjacent subdural hygroma) in pediatric patients with previously asymptomatic arachnoid cysts.

Methods: Patients with arachnoid cysts and intracystic hemorrhage, adjacent subdural hygroma, or adjacent subdural hematoma treated at a single institution from 2005 to 2010 were retrospectively identified. Two unruptured/nonhemorrhagic controls were matched to each case based on patient age, sex, anatomical cyst location, and side. Risk factors evaluated included arachnoid cyst size, recent history of head trauma, and altitude at residence.

Ahead of Print: Risk Factors for Pediatric Arachnoid Cyst Rupture/Hemorrhage

Background: As the availability of imaging modalities has increased, the finding of arachnoid cysts has become common. Accurate patient counseling regarding physical activity or risk factors for cyst rupture or hemorrhage has been hampered by the lack of definitive association studies.

Objective: This case-control study evaluated factors that are associated with arachnoid cyst rupture (intracystic hemorrhage, adjacent subdural hematoma, or adjacent subdural hygroma) in pediatric patients with previously asymptomatic arachnoid cysts.

Methods: Patients with arachnoid cysts and intra-cystic hemorrhage, adjacent subdural hygroma, or adjacent subdural hematoma treated at a single institution from 2005 to 2010 were retrospectively identified. Two unruptured/non-hemorrhagic controls were matched to each case based on patient age, sex, anatomical cyst location, and side. Risk factors evaluated included arachnoid cyst size, recent history of head trauma, and altitude at residence.

Ahead of Print: Transventricular Endoscopic Fenestration of Intrasellar Arachnoid Cyst

Background: To manage arachnoid cysts, incorporation with the normal circulation is the single most important determinant of success. Although the postoperative CSF leakage rate is 3.9% for all cases of transsphenoidal surgery, it is 21.4% for intrasellar arachnoid cysts.

Objective: To present a safe, relatively easy, and effective treatment option for very rare intrasellar arachnoid cysts (IAC).

Methods: We performed a prospective study of intrasellar cystic lesions without a solid portion. Endoscopic exploration and fenestration were performed for all lesions under neuronavigational guidance. We analyzed presenting symptoms, endocrinological status, and magnetic resonance images (MRI).

Video: Intracranial Cysts Containing CSF-like Fluid: Results of Endoscopic Neurosurgery Video 4

This video demonstrates that the endoscopic fenestrations may be as wide and extended as the microsurgical ones. As soon as the neurovascular structures are identified, the arachnoid dissection is conducted in the optico-carotid cistern with the progressive exposure of optic nerve, ICA, MCA, and ACA.

Video: Intracranial Cysts Containing CSF-like Fluid: Results of Endoscopic Neurosurgery Video 3

This video demonstrates the neuronavigator is useful to approach precisely the target, but the final step has to be performed sailing by sight. In this case of opaque cyst wall, the fenestration is performed under endoscopic control basing on the neuronavigator information. There is no “shift effect” and the fenestration is precisely performed where it has been preoperatively planned.