Neuroendoscopy for Intracranial Arachnoid Cysts in Infants: Therapeutic Considerations

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.

Endoscopic Trans-Aqueductal Procedures for Juxta 4th Ventricular and Posterior Fossa Arachnoid Cyst using Flexible/Video Neuroendoscope: A Novel Approach

“…Novel idea of endoscopic transaqueductal cysto-ventriculostomy has shifted the difficulty in approach towards an easy, less laborious procedure; video neuroendoscopy, more precise adjunct causes minimal damage to the surrounding structures and reduces associated complications. Success of neuroendoscopy for ACs in infants, 8 has demonstrated the practicality in younger patients, which is proven in the 20 day old neonate in our series.…”

Symptomatic Unilateral Subdural Effusion as the First Presentation of Suprasellar Arachnoid Cyst

“…Fahad et al reported a case that presented with precocious true puberty. The neurological deficit also can arise from the compression of adjacent structures [10,11]. The exact pathogenesis of subdural hematoma has not been detected so far.…”