In a first, PGI docs develop brain cyst management technique for kids
PGI neurosurgeons have developed a guideline on how to endoscopically manage and treat brain cysts in children below the age of 5 years for the first time in the world medical literature.
Before this, the doctors used to decide the type of surgery based on hit-and-trial. Hence, the health of the kids would take a lot of time to improve. Dr S S Dhandapani, a PGI neurosurgeon who led the team said that “There had been no such classification in world literature. Most of the current classifications do not help decide the treatment. Endoscopy is going to help surgeons in the future to determine which is the best approach for an individual patient.”
“Over the past few decades, endoscopic surgery has become very helpful in dealing with such cysts using just a small hole. But, there was no way of knowing which type of endoscopic surgery may be beneficial in different categories of patients,” Dr Dhandapani said. The classification has been published in the ‘World Neurosurgery’ journal.
PGI doctors, while reviewing such patients noticed that some improved within a week, while others gradually improved in 2-3 months.
Brain cysts are one of the causes of hydrocephalus, a condition of increased fluid accumulation inside the brain. The most commonly used method until now was to place a tube (shunt) from the cyst till the abdomen. “With this, the symptoms can remain present. Moreover, due to the tube placed in children, they might need multiple surgeries once they grow up. There can be many side effects due to the shunt too,” added Dr Dhandapani.
The results and conclusions of the classification were as follows;
There were 13 children aged 3–48 months. Type 1A DRCC was noted in 5 patients, with onset before 6 months, 4 of whom (80%) had intracranial hypertension. All underwent suboccipital endoscopic deroofing and cisternostomy (SEDC), a new technique. Type 1B DRCC was seen in 2 patients, with onset at 8–9 months, who underwent endoscopic third ventriculostomy (ETV) + endoscopic ventriculocystostomy (EVC). Type 2A DRCC was observed in 4 patients, with onset at 5–47 months, who underwent SEDC. Type 2B DRCC was noted in 2 patients, with onset 6–8 months, who underwent ETV. With a mean follow-up of 32 months, all showed clinicoradiologic improvement. The application of our classification to other studies showed ETV/EVC to be successful in only 67% of type 1A DRCC and 72% of type 2A DRCC, compared with 100% efficacy of SEDC in our series.
Conclusions:
This is probably the first-ever endoscopic classification of pediatric posterior fossa cysts, elucidating pathophysiology, presentation, and treatment. Patients with type 1 DRCC present early because of extraneous compression. Among patients with type 2 DRCC, posterior fossa compliance determines the degree of hydrocephalus. The newly described SEDC seems more appropriate for types 1A and 2A DRCC. ETV is adequate in type 2B DRCC and effective with EVC in type 1B.
Source: Times of India, World Neurosurgery Journal.