FP09
Supratentorial arachnoid cysts: The IRCSS G. Gaslini experience
Francesca Secci, Marcello Ravegnani, Gianluca Piatelli, Alessandro Consales, Marco Pavanello, Armando
Cama
IRCSS G.Gaslini, Neurosurgery C.O.U., Genova, Italy
From the 2000 to the 2013, 86 patients were treated for supratentorial arachnoid cyst at Gaslini Institute.
62 males and 24 females (2,6:1). Median age 21,3 months (minimum 0, maximum 184). 12 patients (15%)
by prenatal diagnosis. Site distribution: middle fossa 47(55%); convexity 15 (17%); interemispheric 12(14%);
lamina quadrigemina 5(6%), suprasellar 5(4%); paraventricular 2(2%).
Clinical Findings: 51 (59%) patients were symptomatic, while 35(41%) were incidental findings. Among
these last patients 12 by prenatal diagnosis; 7 by postnatal diagnosis and 16 accidental diagnosis (posttraumatic, etc).
Surgical Criteria: Symptoms at or after the discovery; increase of the cyst during the follow up; large cysts
with evident brain compression.
Surgical Treatment: Shunt 21 patients (24%); microsurgical fenestration (MF) 48 patients (55%); endoscopic
fenestration (EF) 27 patients (20%).
Clinical Outcome: ICP reduction 94%; seizures reduction 55%; disappearance of focal deficit 42%;
improving of comportamental disorders 40%; reduction of endocrinological disorders 33%.
Radiological Outcome: Cyst volume decrease 66,3%; cyst volume unchanged 32,5%; cyst volume increased
1,2%. In our experience the best outcome is both with clinical and radiological good results, but if it is not:
better clinical outcome than radiological one.
Follow Up: 61,5 months (min 4, max 168). Among patients treated by shunt 9/21 (43%) needed reinterventation; while only 6/44 of the patients treated by MF underwent a new operation and 5/17 (29%)
of the patients treated by EF had to be re-operated.
Which is best surgical treatment: MF: 58% with a good outcome and 2% of re-operations; EF: 76% of good
results with 29% of re-operations; shunt: 95% of good results but 43% of new surgeries.
Conclusions: 1) Patients who have to be surgically treated are: symptomatic at the onset or later in follow
up; with increasing of the cyst; asymptomatic but with cerebral “mismatch”.
2) Considering the best outcome with the less re-operations we propose this different surgical approach:
MF for middle base and convexity cysts; EF for suprasellar, interemispheric, paraventricular, lamina
quadrigemina cysts; shunt (with programmable valve) only as last chance or in particular cases (for example
bilateral cysts) and possibly as transitory solution.
QUESTION 2 | Surgical procedure: Which kind of surgical treatment allows the best long-term results? • Free presentations