The parallel use of endoscopic fenestration and a cystoperitoneal shunt with programmable valve to treat arachnoid cysts: experience and hypothesis

Abstract

The authors share their experience of the treatment of arachnoid cysts with endoscopic fenestration and cystoperitoneal shunt placement during the same operation. The importance of this strategy is related to the fact that the shunt can induce the collapse of the cyst and that the endoscopic fenestration could make it possible to remove the shunt, avoiding the phenomenon of shunt dependence. Between 1996 and 2005, 35 patients with an arachnoid cyst were treated using endoscopic fenestration and placement of a programmable shunt. The patients' ages (70% boys and 30% girls) ranged from 2 months to 16 years. These patients were reviewed with MR imaging and clinical examination. The cyst volumes and clinical examinations were evaluated. No serious complications were reported; the cyst disappeared in 60% of the cases, and in 54% of the cases it was possible to remove the shunt without shunt dependence. In the authors' view, this strategy seems easy, does not take longer than a simple shunt surgery or an endoscopic cystostomy alone, and can be useful for treatment of arachnoid cysts in all locations.