ИСТИНА

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