Turkish Neurosurgery
Supraorbital Keyhole Microsurgical Fenestration of Symptomatic Temporal Arachnoid cysts in Children, Advantages and Limitations.
Sherif Elkheshin1, Ahmed Soliman1
1Tanta University Hospital, Neurosurgery, Tanta,
DOI: 10.5137/1019-5149.JTN.18331-16.2

Aim:To investigate the impact of endoscope assisted microsurgical fenestration of temporal arachnoid cysts, the advantages and limitations of the technique.Material and Methods:Retrospective study including twenty five children of symptomatic temporal arachnoid cysts operated via Eyebrow Supra-Orbital Keyhole Microsurgical Fenestration targeting medial cyst wall, Preoperative MRI brain was done for all patients.Results:Preoperative, clinical presentation included headache (80%), nausea & vomiting (64%), drug resistant epilepsy (52%), macrocephaly (12%) papilledema (28%) motor weakness in the form of right sided hemiparesis (12%) and cranial nerve palsy. Post-operative complete subsidence of headache was noted in 50% while 20% remained unchanged. Drug resistant epilepsy improved in 69% of patients. Post-operative MRI showed initial decrease in cyst volume as early as 3 month, only in a range of 5-12% volume reduction, the late follow up done at 6 and 18 months continued to show further reduction reported to be significant(P<0.001). Transient subgalial CSF collection was the most common complication (20%). Only 1 patient experienced CSF leak mandating cysto-peritoneal shunting. Conclusion:Eyebrow Supra-Orbital Keyhole Microsurgical Fenestration for temporal arachnoid cysts can be performed with a fairly low risk of complications and yields favorable improvement in clinical and neuroimaging outcomes.

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