Neuroendoscopic fenestration of glioependymal cysts to the ventricle: report of 3 cases

Abstract

Glioependymal cysts are rare congenital lesions of the central nervous system. Reported surgical treatments of these lesions have varied and yielded mixed results, and the optimal surgical strategy is still controversial. The authors here report the clinical and surgical outcomes for three adult patients successfully treated with neuroendoscopic fenestration into the ventricular system. The patients had presented with symptomatic glioependymal cysts in the period from 2013 to 2016 at the authors’ institution. All underwent minimally invasive neuroendoscopic fenestration of the glioependymal cyst into the lateral ventricle via a stereotactically guided burr hole. Presenting clinical and radiological findings, operative courses, and postintervention outcomes were evaluated.All three patients initially presented with symptoms related to regional mass effect of the underlying glioependymal cyst, including headaches, visual disturbances, and hemiparesis. All patients were successfully treated with endoscopic fenestration of the cyst wall into the lateral ventricle, where the wall was thinnest. Postoperatively, all patients reported improvement in their presenting symptoms, and neuroimaging demonstrated decompression of the cyst. Clinical follow-up ranged from 4 months to 5 years without evidence of reexpansion of the cyst or shunt requirement.Compared to open resection and shunting of the cyst contents, minimally invasive endoscopic fenestration of a glioependymal cyst into the ventricular system is a safe and effective surgical option. This approach is practical, is less invasive than open resection, and appears to provide a long-term solution.

Epilepsy as a Presentation of a Neuroglial Cyst Associated with Dysgenesis of Corpus Callosum in a Child

“…Histopathological analysis of the tumor is not necessary to make the diagnosis because the MRI radiological semiology of the lesion and its association with the abnormalities of the corpus callosum are sufficient to make this diagnosis [ 5 ].…”

“…The differential diagnoses of neuroglial cysts are arachnoid cyst, epidermoid cyst, ependymal cyst, and porencephalic cyst [ 5 ]: Arachnoid cyst typically presents as an unilocular extra-axial cystic lesion which has the same signal as CSF, its outlines are sharp and smooth, and it can displace or deform adjacent brain or adjacent calvarium (scalloping). The arachnoid cyst does not enhance [ 6 ] Epidermoid cysts appear as lobulated CFS-like mass that fills and expand CSF spaces and exerts a gradual mass effect, insinuating between structures and encasing adjacent nerves and vessels.…”

“…There are many methods used: a cysto-peritoneal or cysto-ventricular bypass, partial or total resection [ 2 ]. Neuroendoscopic cyst fenestration is a minimally invasive technique of low morbidity with very short hospitalization and long-term efficacy [ 5 ]. For small, asymptomatic cysts discovered incidentally, surgical treatment is not necessary and monitoring is recommended [ 5 ].…”

Retrocerebellar Ependymal Cyst Presenting with Obstructive Hydrocephalus in an Infant

“…Due to the rarity of this entity, the management is still unclear. Some authors support close follow-up in asymptomatic cases, 1,8,20 and others recommend surgical treatment in asymptomatic patients in case of significant ventricular enlargement 18 or in infants. 31 The most common approach is an open craniotomy with total or partial resection of the cyst wall, with or without a fenestration or shunting of the cyst into the ventricles or subarachnoid space.…”

“…[33][34][35][36][37] Likewise, a slow emptying of the cyst should be performed to prevent the sudden appearance of a space between the dura mater and the brain and to prevent the rapid decrease in intracranial pressure because both events can lead to the appearance of a subdural hematoma. These collections usually appear at the initial follow-up and do not usually require surgical intervention 1,8,38,39 The clinic usually subsides completely after surgery and the recurrence rate is low. However, patients must be closely followed over time.…”