{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T08:29:32Z","timestamp":1764664172097,"version":"3.46.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Congenital intracranial cystic lesions\u2014epidermoid, dermoid, neurenteric, Rathke, colloid\u2014encompass a heterogeneous group of entities whose surgical behavior is only partly explained by histology. We propose a dual-axis cisternal topographic model (medial\u2013lateral\u2009\u00d7\u2009dorsal\u2013ventral) to compare surgical outcome in congenital intracranial cystic lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 110 patients with histologically confirmed congenital intracranial cysts undergoing surgical resection at a single tertiary center. Each lesion was categorized by cisternal topography in coronal and axial planes, and correlations were assessed between topographic class, surgical parameters, recurrence, and outcomes. Inter-rater reliability of classification was measured using Cohen\u2019s kappa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Lesions with complex cisternal topography\u2014defined as extension across dorsal\u2013ventral (multicompartmental, MCL) or combined median-paramedian compartments\u2014showed higher recurrence (42.1% and 50%, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), including late recurrence beyond five years (23.7% and 35%, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). MCL carried greater surgical morbidity: higher rates of subtotal resection (44.7% vs. 8.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), prolonged hospitalization, and doubled complication burden (52.6% vs. 25%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Functional outcomes were poorer in these subgroups (median GOS\u2009=\u20094, IQR: 4\u20135), and neurological sequelae, particularly cranial nerve VII\/VIII deficits and cerebellar signs, were disproportionately more frequent. A strong correlation emerged between cyst topography and histopathology, epidermoids predominating in complex configurations (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Supplementary analyses indicated that although cyst size varied across histological subtypes, it was not associated with recurrence, and in multivariable models cisternal localization remained significant, whereas histology and maximum dimension did not.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cisternal topography was associated with recurrence, surgical complexity, and postoperative outcome in congenital cystic lesions. Lesions with multicompartmental or midline-paramedian axial spread carry a high-risk profile and warrant extended surveillance beyond five years. This dual-axis anatomical model may inform more tailored operative strategies and long-term follow-up planning, complementing histological diagnosis in modern skull base surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-025-06722-1","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T19:07:17Z","timestamp":1764616037000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A dual-axis cisternal classification for congenital intracranial cystic lesions: implications for surgical strategy and long-term prognosis"],"prefix":"10.1007","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2499-3399","authenticated-orcid":false,"given":"Maria Mihaela","family":"Pop","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3407-4895","authenticated-orcid":false,"given":"Dragos","family":"Bouros","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artsiom","family":"Klimko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioan Alexandru","family":"Florian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian Ionel","family":"Abrudan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioan Stefan","family":"Florian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"6722_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2024.109293","author":"S Ahuja","year":"2024","unstructured":"Ahuja S, Shankar M, Mankotia DS, Shankar KB, Zaheer S (2024) Epidermoid cyst of central nervous system: a case series and review of literature. 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This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and was approved by the Cluj-Napoca County Emergency Clinical Hospital, Research Ethics Committee (No. 20837\/26.05.2021) and by the Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Research Ethics Committee (No.283\/15.07.2021).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate"}},{"value":"Not applicable as all personal information is anonymized and the submission does not include images that may identify patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"309"}}