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Shunt dependent hydrocephalus after fenestration of arachnoid cysts in childrenтезисы доклада Электронная публикация Тезисы
- Авторы: Anton Korshunov, Youry Kushel, Armen Melikian
- Сборник: ESPN 2017 Consensus Conference on Arachnoid Cysts Abstracts
- Тезисы
- Год издания: 2017
- Аннотация: Introduction: Suprasellar (SS) and sylvian fissure (SF) are two most common arachnoid cyst (AC) locations in children. In both locations cyst fenestration is straightforward. Fenestration can be done by means of endoscopy or microsurgery and provide benefit of shunt independent life to the majority but not all children with AC’s. In this report we aimed to analyze whether shunt dependent hydrocephalus after fenestration of AC is associated with surgical technique (microsurgery vs endoscopy), cyst location (SSAC vs. SFAC) or patient age. Materials and Methods: We retrospectively reviewed electronic medical records of our department to identify children (<18 y/o) who had their first surgery for SSAC or SFAC from 1999 to 2016 by means of endocopic or microsurgical fenestration. Patients initially operated at other hospitals or those who already had a CSF shunt at time of fenestration were not included. Postoperative course, follow up records and departmental medical image database were reviewed to identify patients who required CSF shunt insertion after initial cyst fenestration. Results: According to inclusion criteria we identified 142 patients; including 73 with SSAC’s (all had endoscopic fenestrations) and 69 with SFAC’s (46 microsurgical and 23 endoscopic fenestrations). Mean patient age was 5,4 y/o (0,2-18). Follow up ranged from 1 to 184 months (mean 22,5). During follow up 19 patients (13,3%) required CSF shunt insertion including 17 VP shunts, 1 LP shunt and 1 subduro-peritoneal shunt. 1 patient (0,7%) had repeat fenestration of SSAC. Shunt dependent hydrocephalus was strongly associated with age at surgery: mean age of patients who required shunts was 1,9 y/o vs. 5,9 y/o of those who remained shunt independent (p=0,002 – Student’s t test). 30% of patients younger than 1 y/o become shunt dependent, compared with 26% of patients aged 1- 2 y/o and 4% of patients >2 y/o at surgery. Shunt dependent hydrocephalus occurred equally often in patients with SSAC (16%) or SFAC (10%), p=0,4 (Fisher’s exact test); its incidence also did not correlate with surgical technique (endoscopy (12,5%) vs microsurgery(15,2%), p=0,3(Fisher’s exact test)). Conclusion: Shunt dependent hydrocephalus after fenestration of AC’s in children is strongly associated with age at surgery of less than 2y/o; it is not related to surgical technique (endoscopy vs microsurgery) or cyst location (SSAC vs SFAC). These data need to be considered while discussing surgical indications and timing of AC fenestration in children.
- Добавил в систему: Коршунов Антон Евгеньевич