MIDDLE FOSSA ARACHNOID CYSTS IN CHILDREN - REVIEW OF 75 CASES AND COMPARATIVE-STUDY BETWEEN MEMBRANECTOMY WITH OPENING OF THE CISTERNS AND CYSTOPERITONEAL SHUNT

The authors report their experience concerning 75 cases of middle foss a arachnoid cysts observed in children during the period 1975-1993, 47 of which (62.6 %) were operated upon. The aim of this study was to st udy the clinical presentation of these cysts, to discuss the surgical indications and to compare the results of the various techniques used to treat these malformations. Head injury was revealing in 17 cases (2 2.6 %) and among these, 12 patients presented intracranial complicatio ns (subdural effusions; 6 cases, subdural hematomas : 4 cases and intr acystic hematomas : 2 cases). The most usual signs and symptoms were : intracranial hypertension (25.3 %), epilepsy (16 %) and temporal bulg ing (24 %). Twenty-one patients (44.7 %) underwent a cystoperitoneal s hunt; 20 patients (42.5 %) were treated by membranectomy with opening of the basal cisterns and removal of intracystic (2 cases) or subdural hematoma (4 cases); 2 patients (4.3 %) were treated using membranecto my, opening of the cisterns and cystoperitoneal shunt and 4 patients ( 8,4 %) underwent a subduroperitoneal shunt. The long-term results were good regardless of the surgical procedure; nevertheless, only one pat ient among 20 cases treated by membranectomy and opening of the cister ns developped complications (5 %), while multiple shunt revisions were necessary in 11 children (40.7 %) out of 27 where a shunt was inserte d. The authors conclude that membranectomy and opening of the basal ci sterns is the procedure of choice to treat middle fossa arachnoid cyst s in children.