ИСТИНА

OBJECTIVE:Fenestration of suprasellar (SS) and sylvian fissure (SF) arachnoid cyst (AC) is straightforward and provide benefit of shunt inde-pendent life to the majority but not all affected children. We aimed to analyze whether shunt dependent hydrocephalus after fenestration of AC is associated with surgical technique (microsurgery vs endoscopy), cyst location (SSAC vs. SFAC) or patient age. MATERIAL-METHODS:We retrospectively reviewed electronic records of our department to identify children (<18 y/o) who had their first surgery for SSACor SFAC from1999 to 2016 bymeans of endoscopic or microsurgical fenestration. Postoperative course, follow up records and departmental medical image database were reviewed to identify patients who required CSF shunt insertion after initial cyst fenestration. RESULTS:141 patients were identified including 72 with SSAC’s(all had endoscopic fenestrations) and 69 with SFAC’s (46 microsurgical and 23 endoscopic fenestrations). Followup ranged from1 to 184months (mean 22,5). 20 patients (14,1%) required CSF shunt insertion including 18 VP shunts, 1 LP shunt and 1 subduro-peritoneal shunt. 1 patient (0,7%) had repeat fenestration of SSAC. Shunt dependent hydrocephalus was strongly associated with age at sur-gery: mean age of patients who required shunts was 1,9 y/o vs. 5,9 y/o of those who remained shunt independent (p=0,002–Student’s t test). 30% of patients younger than 1 y/o become shunt dependent, compared with 26% of patients aged 1-2 y/o and 4% of patients >2 y/o at surgery. Surgical technique and cyst location did not correlate with shunt dependency. CONCLUSIONS:Shunt dependent hydrocephalus after fenestrationofAC’s in children is strongly associated with age at surgery of less than 2y/o and is not related to surgical technique or cyst location. This need to be consid-ered while discussing indications and timing of surgery for AC in children.