Prognostication of cystic paediatric intracranial lesions: An attempt in the light of retrospective analysis

Saha; Dev, Buddha; Tripathy, P.; Ghorai, S. P.; Ghosh, S. N.; Deb, P.; Chowdhury, A. K.; Saha, S. K.
July 2007
Journal of Pediatric Neurosciences;Jul-Dec2007, Vol. 2 Issue 2, p98
Academic Journal
AIM: Cystic Paediatric intracranial lesions constitute a sizeable proportion of I.C.S.O.L's. They are mostly benign and eminently treatable because of their nature as well as constitution. Even, malignant lesions are generally of low grade. Hence, they merit special categorization, as a positive outlook can be nurtured in their management. MATERIALS AND METHODS: At Bangur Institute of Neuroscience and Psychiatry, during January 2001 to December 2006 of 107 paediatric I.C.S.O.L's (29.88% of all paediatric neurosurgery), 31 were cystic intracranial lesions (28.97% of paediatric I.C.S.O.L's). We present here a critical study of these S.O.L's with respect to type, frequency, age, sex, clinical features, treatment modalities and results. They were divided in to two groups: 0-2 years and 2+ -10 years and farther subdivided into supratentorial and infratentorial locations. RESULTS: In our series of 31 patients, only one child with D.W. Malformation with enlarged Thymus, succumbed in the early postoperative period, while one child with Craniopharyngioma developed Diabetes Insipidus in the postoperative period which could be controlled with the available resources. All other patients could be discharged home without any serious or persistent sequalae. Nearly 20 patients are under acceptable follow up for a period from 1-6 years, with a mean of 2.5 years. Amongst supratentorial lesions, most of the benign lesions are fully cured and have returned to normal activities, consistent with children of their age group. Nearly all children with Craniopharyngiomas in our series have received postoperative Radiotherapy. Of these, 2 patients have undergone revision of V.P shunt for malfunctioning. Supratentorial Medulloblastomas in our series were mainly cystic and are recurrence free till date. Astrocytomas both supra and infratentorial were cystic and of low grade. They received postoperative Radiotherapy and are recurrence free. Of the cystic paediatric infratentorial lesions, nearly 50% are under acceptable follow up. They are all doing well with normal activities and intelligence levels. CONCLUSION: At Bangur Institute of Neuroscience and Psychiatry, while retrospectively analyzing 107 paediatric ICSOL.s operated during January 2001 to December 2006, we came across 31 intracranial cystic lesions (28.97% paediatric ICSOL's) which was a sizeable portion. These lesions were essentially benign. Only two cases had proved to be low-grade gliomas. We had also encountered two cases of medullblastoma with cystic component in supratentorial location in below 10 years age group, which is most unusual. Having cyst as their main component, they were eminently resectable or treatable and has shown encouraging follow up result till date. Because of dominant cystic component in the medulloblastomas and low-grade gliomas in our series, near total excision could be done. With adjuvant radiotherapy they have not recurred till date. Thorough review of available literature and a survey of text books have guided us in our endeavour to consider cystic intracranial lesions to be a conglomerate of various pathological entities which are nearly uniformly of favorable prognosis, through cystic intracranial lesions have never been considered as a pathological group in itself. With further prospective study we feel that our understanding of the situation will guide us in future in parent counseling by making them aware of the positive prognostic outcome of these lesions.


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