Endoscopic therapy for obstructive hydrocephalus caused by cysts in the pathway of CSF circulation

Abstract

To explore the process and technique of neuroendoscopic operation to treat obstructive hydrocephalus caused by cysts located in the pathway of CSF circulation. The cine MRI examinations and endoscopic operations were taken to treat 30 cases with obstructive hydrocephalus. Among all the cases, there are 11 intraventricular cysts (8 lateral ventricular cysts, 4 fourth ventricular cysts), 4 suprasellar arachnoid cysts, 1 quadrigeminal cistern arachnoid cyst, 6 Dandy-Walker malformations and 8 posterior fossa arachnoid cysts. CSF dynamic of all patients improved to different extents post-operation. It was observed that CSF passed through the stoma after ETV in all patients. The volume of 9 intraventricular cysts, 4 suprasellar arachnoid cysts, 1 quadrigeminal cistern arachnoid cyst and 4 posterior fossa arachnoid cysts diminished for different degrees. There were no surgery-related serious complications or deaths. There were not cyst enlarged and stoma obstructed cases. Obstructive hydrocephalus caused by cysts in the pathway of CSF circulation is the optimal indication for neuro-endoscopic surgery. After resecting cyst partially, we should take the endoscopic third ventriculostomy to rebuild the passway of CSF and elevate the cranial compliance. Cine MRI and radionuclide cisternography are helpful to understand the CSF dynamic and absorption.