Hydrocephalus in children with middle fossa arachnoid cysts.

OBJECT: The optimal management of children with middle fossa arachnoid cysts (MFACs) remains controversial. In this study the authors evaluated the relationship between two preoperative variables, hydrocephalus and nonspecific macrocephaly, in children undergoing fenestration of temporal arachnoid cysts and hydrocephalus-related shunt placement.
METHODS: During a 16-year period, 40 children (30 boys and 10 girls) underwent treatment of MFACs. All but one patient experienced either worsening symptoms or progressive serial imaging-documented cyst enlargement. Hydrocephalus was present in six patients and nonspecific macrocephaly in another nine. The mean age at surgery was 66 months (range 1-201 months, median 36 months), and the mean follow-up duration was 54 months (range 6-83 months, median 39 months). All patients presenting with hydrocephalus required placement of a ventriculoperitoneal (VP) shunt as well as cyst fenestration, regardless of which procedure was performed first. Five patients with macroencephaly undergoing initial fenestration required subsequent VP shunt insertion. Complications of cerebrospinal fluid (CSF) diversion were typical.
CONCLUSIONS: Patients with hydrocephalus or macrocephaly are likely to require VP shunt placement in addition to cyst fenestration. Children with nonspecific macrocephaly may harbor a latent derangement of CSF circulation.