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. 2024 Dec;40(12):4033-4046.
doi: 10.1007/s00381-024-06596-1. Epub 2024 Sep 13.

Early clinico-radiological outcomes following neuroendoscopic cysto-cisternostomy for middle cranial fossa arachnoid cysts: a prospective cohort study with illustrative cases

Promise Tamunoipiriala Jaja  1   2   3 , Yakimov Yuri  4   5 , Albert Sufianov  4   5   6
Affiliations

Early clinico-radiological outcomes following neuroendoscopic cysto-cisternostomy for middle cranial fossa arachnoid cysts: a prospective cohort study with illustrative cases

Promise Tamunoipiriala Jaja et al. Childs Nerv Syst. 2024 Dec.

Abstract

Background: The dysmorphogenetic arachnoid cysts' pathomechanism is most favoured, and about 50% occur as middle cranial fossa cysts (MCFAC). Still being rare, management options are yet evolving. We described the clinico-radiological features, management and early outcomes of participants with MCFAC in our service.

Methods: This prospective cohort study involved 29 pediatric participants recruited (from electronic health records, using ICD G93.0 D016080 for arachnoid cysts) between 01/01/2023 and 31/06/2023, following informed consent according to the ethical approval. All participants had neuro-imaging confirmed MCFAC. Baseline and follow-up data were retrieved and analyzed using summary (mean, standard deviation) and inferential (ANOVA, t-test) statistics.

Results: They were averagely aged 6.2 ± 4.48 years and were mostly males (89.7%). 24.1% were asymptomatic. The commonest symptoms (n = 38) were headaches (23.7%), developmental delays (15.8%), eye complaints (15.8%) and cephalomegaly (7.9%). They were predominantly left-sided (89.7%). Galassi (G) 3 lesions were less (24.1%), with G2 and G1 lesions evenly sharing the rest. The average cyst volume was 58.4 ± 80.83cm3; there were significant differences (F = 4.682; p = 0.018) between the average volumes for G1 (14.4 ± 22.42cm3), G2 (61.7 ± 89.92cm3) and G3 (122.5 ± 94.37cm3) lesions. 44.8% of the participants had rigid-endoscopic cysto-cisternotomy (all between the ICA and oculomotor nerve into the interpeduncular cistern, using ventriculostomy forceps); including all G3, 50% of G2 and no G1 (had serial clinico-radiological observation) lesion. The average pre- (117.42cm3) and post-operative (53.48cm3) cyst volumes showed significant (t = - 2.797, p = 0.021) reductions.

Conclusion: Middle cranial fossa arachnoid cysts occur predominantly amongst males, in middle childhood and left-sided. The treatment-related patient series are largely symptomatic, unlike the largely asymptomatic, screening-related series. Higher Galassi grade lesions presented with progressively, significantly larger cyst volumes and higher likelihoods of surgery. The average post-operative cyst volume at follow-up averagely showed almost 60% reduction from the pre-operative. All participants reported clinical remission.

Keywords: Cysto-cisternostomy; Intracranial arachnoid cysts; Middle cranial fossa; Neuroendoscopy.

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Conflict of interest statement

Declarations. Ethics approval: The protocol for this study as part of a Candidate of Medical Science - Neurosurgery (analogous to Doctor of Philosophy) thesis proposal was reviewed by the Local Ethical Committee (LEC) of the I. M. Sechenov First Moscow State Medical University, Moscow. Upon approval, it was granted 2023 protocol number 04. This ensured that the research was in accordance with the 1964 Helsinki Declaration and its subsequent amendments for ethical human studies. All participants assented, while their parents granted written informed consent to participate in this study, after reading the information leaflet for this study. Conflict of interest: The authors declare no competing interests.

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References

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