INTRODUCTION When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy –implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques.

PATIENTS AND METHODS This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial.

RESULTS Treatment involved a cyst-peritoneal or ventriculoperitoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred.

CONCLUSIONS The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts.

Introducción Los quistes aracnoideos (QA) deben tratarse quirúrgicamente cuando son sintomáticos. Actualmente persiste todavía la controversia sobre la mejor técnica quirúrgica: derivación cistoperitoneal (CPS) o fenestración del quiste, bien mediante craneotomía o por técnicas endoscópicas.

Pacientes y métodos Se presentan los resultados de una serie de 18 pacientes con edad inferior a los 10 años que se han tratado de QA sintomáticos. 12 pacientes presentaron aumento del perímetro craneal, 4 cefaleas y 2 niños crisis comiciales. La localización ha sido supratentorial en 11 casos y 7 intratentorial.

Resultados En 12 casos el tratamiento realizado ha sido la derivación cistoperitoneal o ventriculoperitoneal. En 5 pacientes se ha realizado tratamiento endoscópico del quiste y en 1 caso desbridamiento mediante craneotomía. De los 18 niños, 7 han precisado una segunda intervención para resolver la clínica, bien por mal funcionamiento valvular o por insuficiencia del tratamiento endoscópico. Como complicaciones se han producido 2 hematomas subdurales, que han precisado tratamiento quirúrgico. No se ha producido mortalidad ni morbilidad.

Conclusiones Los avances en técnicas endoscópicas pueden ser el tratamiento ideal frente al desbridamiento por craneotomía, aunque hay que tener en cuenta el alto porcentaje de no resolución en niños de menos de 15 meses. La CPS soluciona el problema de estos quistes con menor riesgo quirúrgico, pero tiene un alto índice de reintervenciones, además de la dependencia del shunt. En la revisión bibliográfica realizada se comprueba que se publican todavía series tratadas tanto con fenestración del quiste como mediante derivación.