Neuroendoscopy for Intracranial Arachnoid Cysts in Infants: Therapeutic Considerations

 

 Permissions and Reprints

Abstract

Background The use of the endoscope for various cranial procedures is gradually expanding. Intracranial cystic lesions in the brain are one of the most attractive targets for this minimally invasive procedure, thus avoiding conventional craniotomy. These cystic lesions in the brain, namely arachnoid cysts, are congenital. Surgical treatment depends on clinical presentation, location, and age.

Patients A total of 13 patients < 1 year of age with intracranial cysts were operated on between 2005 and 2013. Six presented with hydrocephalus, four presented with seizure, one with abnormal head movement, and two had large asymptomatic cysts. Four children had infratentorial arachnoid cysts; of these, three required a transaqueductal procedure. All the patients underwent endoscopic cystoventriculostomy and/or cystocisternostomy and third ventriculostomy in selected cases with a biopsy from the cyst wall.

Results Clinically and radiologically all children showed significant improvement with an average follow-up ranging from 8 months to 6 years. There were no intraoperative complications. Three children developed subdural hygroma that subsided with conservative treatment, and one child with pseudomeningocele required a cystoperitoneal shunt at a later date.

Conclusion A symptomatic intracranial arachnoid cyst or a large asymptomatic cyst are indications for neurosurgical intervention, and endoscopy is a good treatment option with the advantage of minimal invasiveness and fewer complications. Endoscopic surgery has to be tailored according to the location and presentation.

• References

• 1 Epelman M, Daneman A, Blaser SI , et al. Differential diagnosis of intracranial cystic lesions at head US: correlation with CT and MR imaging. Radiographics 2006; 26 (1) 173-196
  CrossrefPubMedGoogle Scholar
• 2 Rengachary SS. Intracranial arachnoid and ependymal cysts. In: Wilkins RH, Rengachary SS, , eds. Neurosurgery. 2nd ed. New York, NY: McGraw-Hill; 1985: 2160-72
  Google Scholar
• 3 Rappaport ZH. Suprasellar arachnoid cysts: options in operative management. Acta Neurochir (Wien) 1993; 122 (1–2) 71-75
  CrossrefPubMedGoogle Scholar
• 4 Sikorski CW, Yamini B, Frim DM. Endoscopic cyst fenestration outcomes in children one year of age or less. Pediatr Neurosurg 2004; 40 (2) 59-63
  CrossrefPubMedGoogle Scholar
• 5 Rengachary SS, Kennedy JD. Intracranial arachnoid cysts and ependymal cysts. In: Wilkins RH, Rengachary SS, , eds. Neurosurgery. 2nd ed. New York, NY: McGraw-Hill; 1996: 3709-28
  Google Scholar
• 6 Nicholas M, Marion L. Arachnoid cysts. In: Winn HR, , ed. Youmans Neurological Surgery. 6th ed. Philadelphia, PA: Saunders/Elsevier; 2011: 1911-17
  Google Scholar
• 7 Diakoumakis EE, Weinberg B, Mollin J. Prenatal sonographic diagnosis of a suprasellar arachnoid cyst. J Ultrasound Med 1986; 5 (9) 529-530
  PubMedGoogle Scholar
• 8 Oberbauer RW, Haase J, Pucher R. Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 1992; 8 (5) 281-286
  CrossrefPubMedGoogle Scholar
• 9 Caemaert J, Abdullah J, Calliauw L, Carton D, Dhooge C, van Coster R. Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 1992; 119 (1–4) 68-73
  CrossrefPubMedGoogle Scholar
• 10 Galassi E, Piazza G, Gaist G, Frank F. Arachnoid cysts of the middle cranial fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 1980; 14 (3) 211-219
  PubMedGoogle Scholar
• 11 Raffel C, McComb JG. To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?. Neurosurgery 1988; 23 (3) 338-342
  CrossrefPubMedGoogle Scholar
• 12 Schroeder HW, Gaab MR. Endoscopic observation of a slit-valve mechanism in a suprasellar prepontine arachnoid cyst: case report. Neurosurgery 1997; 40 (1) 198-200
  CrossrefPubMedGoogle Scholar
• 13 Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 2010; 5 (6) 578-585
  CrossrefPubMedGoogle Scholar
• 14 Yadav YR, Parihar V, Sinha M, Jain N. Endoscopic treatment of the suprasellar arachnoid cyst. Neurol India 2010; 58 (2) 280-283
  CrossrefPubMedGoogle Scholar
• 15 Koch CA, Moore JL, Krähling KH, Palm DG. Fenestration of porencephalic cysts to the lateral ventricle: experience with a new technique for treatment of seizures. Surg Neurol 1998; 49 (5) 524-532 ; discussion 532–533
  CrossrefPubMedGoogle Scholar
• 16 Gangemi M, Colella G, Magro F, Maiuri F. Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 2007; 21 (3) 276-280
  CrossrefPubMedGoogle Scholar
• 17 Hopf NJ, Perneczky A. Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 1998; 43 (6) 1330-1336 ; discussion 1336–1337
  CrossrefPubMedGoogle Scholar
• 18 Ozek MM, Urgun K. Neuroendoscopic management of suprasellar arachnoid cysts. World Neurosurg 2013; 79 (2, Suppl): e13-e18
  PubMedGoogle Scholar
• 19 Longatti P, Fiorindi A, Feletti A, Baratto V. Endoscopic opening of the foramen of magendie using transaqueductal navigation for membrane obstruction of the fourth ventricle outlets. Technical note. J Neurosurg 2006; 105 (6) 924-927
  CrossrefPubMedGoogle Scholar
• 20 Esmaeeli B, Eftekhar B. Intraparenchymal hemorrhage after surgical decompression of a Sylvian fissure arachnoid cyst. Neurol India 2006; 54 (3) 320-321
  CrossrefPubMedGoogle Scholar