Endoscopic-Guided Proximal Catheter Placement in Treatment of Posterior Fossa Cysts

Sandberg, David I.; Souweidane, Mark M.

doi:10.1159/000028791

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…Treatment of retroclival or intra-fourth ventricular PFAC by cystoperitoneal shunting may be complicated by a malpositioned proximal catheter located within the brainstem or cerebellum causing acute shunt malfunction or neurological deficits. [ 22 ] Sandberg and Souweidane[ 23 ] suggested that proximal catheter placement from a posterior fossa approach can be aided by a malleable endoscope that may prevent malposition and its complications as observed in 3 out of their 4 cases they treated by using this technique. Hence, we suggest this to be performed only by experts in the neuro-endoscopic field.…”

Section: Discussionmentioning

confidence: 99%

Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

Srinivasan

Lawrence

2015

Asian J Neurosurg

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Introduction and Aim:The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.Materials and Methods:We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.Results:In 6 cases the PFAC was located in the midline. In the 7th case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.Discussion:We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.

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Section: Discussionmentioning

confidence: 99%

Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

Srinivasan

Lawrence

2015

Asian J Neurosurg

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“…11,13,19 There have even been endorsements of CT-guided insertion of the catheter in a two-stage proce-dure. 11,13,19 There have even been endorsements of CT-guided insertion of the catheter in a two-stage proce-dure.…”

Section: Discussionmentioning

confidence: 99%

Progressive cranial nerve palsy following shunt placement in an isolated fourth ventricle

Pang

Zwienenberg-Lee²,

Smith³

et al. 2005

Journal of Neurosurgery: Pediatrics

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Cranial nerve palsy is rarely seen after shunt placement in an isolated fourth ventricle. In the few reports of this complication, neuropathies are thought to be caused by catheter injury to the brainstem nuclei either during the initial cannulations or after shrinkage of the fourth ventricle. The authors treated a child who suffered from delayed, progressive palsies of the sixth, seventh, 10th, and 12th cranial nerves several weeks after undergoing ventriculoperitoneal shunt placement in the fourth ventricle. Magnetic resonance imaging revealed the catheter tip to be placed well away from the ventricular floor but the brainstem had severely shifted backward, suggesting that the pathogenesis of the neuropathies was traction on the affected cranial nerves. The authors postulated that the siphoning effect of the shunt caused rapid collapse of the fourth ventricle and while the cerebellar hemispheres were tented back by adhesions to the dura, the brainstem became the only mobile component in response to the suction forces. Neurological recovery occurred after surgical opening of the closed fourth ventricle and lysis of the basal cistern adhesions, which restored moderate ventricular volume and released the brainstem to its normal position.

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“…Different endoscopic techniques may be applied to the surgery of infratentorial arachnoid cysts, including endoscopic cyst fenestration through a burr hole [2,9,12,15,20,23], endoscope-assisted or endoscope-controlled microneurosurgery [12,13], and endoscope-guided proximal catheter placement [22].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Surgery for Large Posterior Fossa Arachnoid Cysts

Gangemi

Maiuri²,

Colella³

et al. 2001

Minim Invasive Neurosurg

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The authors report two cases of large arachnoid cysts of the posterior fossa treated by endoscopic surgery. One patient underwent a successful endoscopic cyst fenestration by burr hole approach after several procedures of shunt revision. In another an endoscope-assisted microsurgical intervention was necessary. Lateral (cerebellar or cerebellopontine angle) cysts, as two reported cases, may be treated through a lateral retromastoid approach by fenestration into the prepontine cistern and eventually into the cisterna magna. We advise to start the operation through a burr hole and to try to realize the fenestration by endoscopy only. If this attempt fails, an endoscope-assisted microsurgical technique may be performed by enlarging the craniectomy. In this last instance the endoscope is useful particularly deeply to fenestrate the anterior cyst wall in the prepontine or ambient cisterns, where it provides more illumination and helps to identify the nervous and vascular structures.

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Endoscopic-Guided Proximal Catheter Placement in Treatment of Posterior Fossa Cysts

Cited by 11 publications

References 6 publications

Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

Progressive cranial nerve palsy following shunt placement in an isolated fourth ventricle

Endoscopic Surgery for Large Posterior Fossa Arachnoid Cysts

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