Endoscopic Treatment of Arachnoid Cyst

Abstract

Introduction The surgical options for symptomatic arachnoid cysts are shunting, endoscopic fenestration, and craniotomy with fenestration. The endoscopic procedure has been found to be minimally invasive, safe, and effective. Results of endoscopic treatment of 21 patients of arachnoid cyst in vicinity to cistern or ventricle are described. Material and Methods All except one of the symptomatic arachnoid cysts with raised intracranial pressure were operated by endoscopic procedure. One patient of convexity cyst without any adjoining cistern/ventricle was excluded from study. Gaab 6-degree rigid telescope was used. Burr hole was made keeping in mind the straight trajectory between the cyst and cistern/ventricle. A minimum of 1 cm hole was made in all the cases. Third ventriculostomy was also done for associated hydrocephalus in quadrigeminal arachnoid cyst. Both the procedures could be done by single burr hole placed about 3–4 cm anterior to coronal suture. Results This is a prospective study of 21 arachnoid cysts. There were 6, 8, 5, and 2 cases of vermian, quadrigeminal region, sylvian fissure region, and cerebello-pontine region arachnoid cyst respectively. Symptomatic improvement occurred in 20 cases, while one infant with quadrigeminal arachnoid cyst required a ventriculo-peritoneal (VP) shunt. There was no mortality or any other complication except 3 cases of CSF leak, which stopped in 7 days time in two cases. Third ventriculostomy was done in the same sitting in 8 cases of quadrigeminal region arachnoid cyst. Follow-up ranged from 6 to 54 months. Conclusion Endoscopic treatment of arachnoid cyst with an adjoining cistern or ventricle is safe and effective. Third ventriculostomy can be done in the same sitting.