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.