Pediatric cerebral cysts: comparison of early complications following fenestration versus shunting procedures

ABSTRACT

Objective: Characterize practice patterns and acute (30-day) surgical complications following fenestration and shunt procedures for the treatment of cerebral cysts in pediatric patients.

Methods: This study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database. Patients were identified by International Classification of Disease codes for cerebral cysts and Current Procedural Terminology codes for shunting or fenestration. Demographic data, preoperative comorbidities, and postoperative complications were compared between the two procedures.

Results: 741 patients were included in the data analysis, with a majority aged 4 years or younger (55.9%) and a male predominance (62.6%). Fenestration was performed in 590 (79.6%) patients. Primary shunting was performed in 151 (20.4%) patients. Patients who received shunts were more commonly aged 0–4 years and had proportionately worse preoperative health status. No statistically significant differences in postoperative complications were detected. Reoperation rate was 7.9% and 8.6% in the shunt and fenestration groups, respectively. Common reasons for reoperation were shunt revision or replacement and shunt placement after fenestration. Patients requiring shunting after a failed fenestration tended to be younger with higher American Society of Anesthesiologists (ASA) classification.

Discussion: Fenestrations are performed more often than shunting. Generally, children who receive shunts are younger than those who undergo fenestration. Acute surgical risk appears to be similar for both operations.

KEYWORDS:

• Arachnoid cysts
• child
• infant
• neurosurgery
• postoperative complications
• ventriculoperitoneal shunt

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Andrew Mudreac

Andrew Mudreac is a fourth-year medical student at the University of Illinois College of Medicine. He received his undergraduate degree in Neuroscience at the University of Miami. His research interests include pediatric neurosurgery and quality improvement.

Mandana Behbahani

Dr. Mandana Behbahani obtained her bachelorette degree from Arizona State University and Medical degree from University of Arizona. She is currently completing her neurosurgical residency training at University of Illinois at Chicago. Throughout her training, she has focused on brain tumor research and plans to pursue a career in pediatric neurosurgery with a focus in pediatric brain tumors.

Ryan G. Chiu

Ryan Chiu is a fourth-year medical student at the University of Illinois College of Medicine. He received his undergraduate degrees in Political Science and Biological Sciences from the University of Illinois at Chicago and was a member of the BA/MD program there.

Shashank N. Patil

Shashank Patil is a currently third-year medical student at the University of Illinois College of Medicine. He completed his undergraduate studies at the University of California, Berkeley with degrees in Molecular and Cellular Biology, Psychology, and Integrative Biology, graduating Magna Cum Laude. After graduating, he spent two years working as a research associate at Verseon Corporation where he supported the progression of several direct thrombin inhibitors into pre-clinical and clinical trials. His research interests include neurosurgical oncology, pediatric neurosurgery, and spinal surgery.

Abhinav K. Reddy

Abhinav Reddy, MS is a third-year medical student at the University of Illinois College of Medicine at Chicago and has previously completed a Masters of Science degree in Computational Biology and Quantitative Genetics. His research interests are in the role of social determinants of health in the delivery of neurosurgical care.

Syed I. Khalid

Dr. Syed I. Khalid is a physician scientist with faculty appointments at the Department of Surgery at Rush University Medical Center and the Chicago Medical School. He has been an awardee of funding from the Howard Hughes Medical Institutes’s (HHMI) Medical Fellows Program and has served on the TEDMED program committee. He is an editor of the Comprehensive Neurosurgery Board Review textbook.

Ankit I. Mehta

Dr. Ankit I. Mehta received his Medical Degree from Harvard Medical School and MIT in the Health Sciences and Technology pathway. He completed an internship in general surgery at Brigham and Women’s Hospital and a residency in neurological surgery at Duke University. During his residency training, Dr. Mehta completed an enfolded stereotactic radio surgery fellowship. After residency, Dr. Mehta completed a complex spine and spinal oncology fellowship at The Johns Hopkins Hospital. Dr. Mehta’s research efforts focus on patients with complex spinal conditions, most notably spinal tumors and spinal deformity.