Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting

S. F. Ciricillo, P. H. Cogen, G. R. Harsh, M. S.B. Edwards

Research output: Contribution to journalArticlepeer-review

204 Scopus citations


The best operative intervention for children with arachnoid cysts remains the subject of controversy. Recent reports stress that craniotomy for cyst fenestration is associated with a low incidence of morbidity and mortality and may leave the chi1d shunt-independent. The cases of 40 pediatric patients with arachnoid cysts treated between 1978 and 1989 are reported. Five children with mild symptoms and small cysts that remained stable on follow-up studies have not required surgical intervention. Of 15 patients with cysts initia1ly treated by fenestration, 10 (67%) showed no clinical or radiographic improvement postoperatively and have undergone cyst-peritoneal (eight patients) or ventriculoperitoneal (VP) shunting (one patient), or revision of a VP shunt placed for hydrocephalus before cyst fenestration (one patient). Two other patients with existing VP shunts required no further procedures. Thus, only three (20%) of 15 patients initially treated by fenestration remain shunt-independent after a median follow-up period of 8 years. The 20 other patients were initially treated by cyst shunting and all improved postoperatively; shunt revision has been necessary in six (30%) of these 20 patients because of cyst recurrence. Cyst location influenced the success of shunt treatment; none of the seven middle cranial fossa cysts treated by shunting have required revision, but results with cysts in other locations were less favorable. In all locations, though, shunting was more successful than fenestration. It is concluded that cyst-peritoneal or cyst-VP shunting is the procedure of choice for arachnoid cysts in most locations, including those in the middle cranial fossa.

Original languageEnglish (US)
Pages (from-to)230-235
Number of pages6
JournalJournal of Neurosurgery
Issue number2
StatePublished - 1991
Externally publishedYes


  • children
  • craniotomy
  • cyst, arachnoid
  • fenestration
  • shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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