Background: Intracranial arachnoid cysts are pathological conditions that occur in 2.6%
of children. Different surgical procedures had significant failure rate.
Objective: A trial to evaluate the effectiveness of open surgical excision in failed firstother surgery.
Methods: Twenty-three patients with symptomatic arachnoid cysts with radiological
evidence who had had one previous failed surgical intervention, shunting or endoscopic
fenestration, underwent open surgical excision of the arachnoid cyst at the Neurosurgery
Department of Benha University and Benha Children Hospitals through the period from
January 2018 to January 2022.
Results: Twenty-three children with intracranial arachnoid cysts (IAC) underwent open
surgical excision, totaling nine cases (39.1%) and partial in fourteen cases (60.9%). In
thirteen cases, associated microscopic fenestration to basal arachnoid cisterns was done.
The mean follow-up period is 28.36±3.97 months with 77.3% success and 22.7% failure
with subsequent treatment by cystoperitoneal shunting. Total excision success is 100%,
but partial excision is 64.3%, with 88.9% of them being associated with microscopic
fenestration. Mild early transient complications were reported in only three cases and
were conservatively treated, but late complications occurred in two cases.
Conclusion: Open surgical excision of IAC has a very good success rate in the
treatment of intracranial arachnoid cysts after initial procedure failure; complete
excision should be the main aim whenever possible for optimum results that force us to
ask: "Could it be the first line of surgical treatment in symptomatic untreated cases?"