{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:33:17Z","timestamp":1789169597381,"version":"build-2803163510"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age, sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma\/hygroma.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and\/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.3.peds14573","type":"journal-article","created":{"date-parts":[[2015,7,31]],"date-time":"2015-07-31T13:59:01Z","timestamp":1438351141000},"page":"533-539","source":"Crossref","is-referenced-by-count":20,"title":["Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children"],"prefix":"10.3171","volume":"16","author":[{"given":"Tomomi","family":"Kimiwada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Miyagi Children\u2019s Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sendai City Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Narisawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sendai City Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reizo","family":"Shirane","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Miyagi Children\u2019s Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teiji","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds14573","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1136\/jnnp.38.1.57","article-title":"Supratentorial extracerebral cysts in infants and children","volume":"38","author":"Aicardi","year":"1975"},{"key":"b2-peds14573","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"578","DOI":"10.3171\/2010.2.PEDS09464","article-title":"Prevalence and natural history of arachnoid cysts in children","volume":"5","author":"Al-Holou","year":"2010"},{"key":"b3-peds14573","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00381-014-2525-1","article-title":"Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children","volume":"31","author":"Choi","year":"2015"},{"key":"b4-peds14573","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1227\/NEU.0b013e318285b3a4","article-title":"Risk factors for pediatric arachnoid cyst rupture\/hemorrhage: a casecontrol study","volume":"72","author":"Cress","year":"2013"},{"key":"b5-peds14573","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/S0090-3019(03)00064-8","article-title":"Prolonged ICP monitoring in Sylvian arachnoid cysts","volume":"60","author":"Di Rocco","year":"2003"},{"key":"b6-peds14573","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"231","DOI":"10.3171\/2011.12.PEDS11298","article-title":"Endoscopic treatment of middle cranial fossa arachnoid cysts in children","volume":"9","author":"El-Ghandour","year":"2012"},{"key":"b7-peds14573","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"158","DOI":"10.3171\/2011.5.PEDS1152","article-title":"Endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid cysts","volume":"8","author":"Gangemi","year":"2011"},{"key":"b8-peds14573","series-title":"J Neurodev Disord","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1866-1955-5-21","article-title":"Intracranial arachnoid cysts: impairment of higher cognitive functions and postoperative improvement","volume":"5","author":"Gjerde","year":"2013"},{"key":"b9-peds14573","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"222.e1","DOI":"10.1016\/j.wneu.2012.11.002","article-title":"Development of intracranial hypertension after surgical management of intracranial arachnoid cyst: report of three cases and review of the literature","volume":"80","author":"Kaliaperumal","year":"2013"},{"key":"b10-peds14573","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1007\/s00381-012-1722-z","article-title":"Enlarging arachnoid cyst: a false alarm for infants","volume":"28","author":"Lee","year":"2012"},{"issue":"1 Suppl","key":"b11-peds14573","series-title":"J Neurosurg","first-page":"25","article-title":"Hydrocephalus in children with middle fossa arachnoid cysts","volume":"101","author":"Levy","year":"2004"},{"key":"b12-peds14573","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1227\/01.NEU.0000089060.65702.03","article-title":"Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration","volume":"53","author":"Levy","year":"2003"},{"key":"b13-peds14573","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1007\/s00381-013-2248-8","article-title":"Shunt dependency syndrome after cystoperitoneal shunting of arachnoid cysts","volume":"30","author":"Li","year":"2014"},{"key":"b14-peds14573","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"551","DOI":"10.3171\/jns.1961.18.4.0551","article-title":"Post-traumatic arachnoidal cyst. 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