Arachnoid cyst surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Treatment for arachnoid cysts occurs when symptoms present themselves. A variety of surgical procedures may be used to decompress (remove pressure from) the cyst. | Treatment for arachnoid cysts occurs when symptoms present themselves. A variety of surgical procedures may be used to [[Decompression|decompress]] (remove pressure from) the cyst. | ||
==Surgery== | ==Surgery== | ||
* There are a number of approaches in treating arachnoid cysts, the most common are: | * There are a number of approaches in treating arachnoid cysts, the most common are: | ||
** Endoscopic fenestration and removal of the cyst ( | **[[Endoscopic]] [[fenestration]] and removal of the cyst wall (advances in neurosurgical techniques favor [[fenestration]] over [[shunt]] insertion as the preferred method for initial management).<ref>Pradilla, Gustavo, and George Jallo. "Arachnoid cysts: case series and review of the literature." ''Neurosurgical focus'' 22.2 (2007): 1-4.</ref> | ||
** Microsurgical fenestration; | ** Microsurgical [[fenestration]]; | ||
** Craniotomy followed by shunting. | **[[Craniotomy]] followed by [[shunting]]. | ||
* Neuroradiology imaging is needed to assess: location of the cyst and its size; | *[[Neuroradiology]] imaging is needed to assess: location of the cyst and its size; | ||
* It is still a controversy which is the best method, some studies state that the fenestration is associated with more complications<ref>Choi, Jung Won, et al. "Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children." ''Child's Nervous System'' 31.1 (2015): 77-86.</ref> while some argue that the endoscopic approach is superior with fewer surgical complications in comparison to craniotomy and shunting,<ref>Lee, Yun Ho, Young Sub Kwon, and Kook Hee Yang. "Multiloculated Hydrocephalus: Open Craniotomy or Endoscopy?." ''Journal of Korean Neurosurgical Society'' 60.3 (2017): 301.</ref> | * It is still a controversy which is the best method, some studies state that the [[fenestration]] is associated with more [[complications]]<ref>Choi, Jung Won, et al. "Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children." ''Child's Nervous System'' 31.1 (2015): 77-86.</ref> while some argue that the [[endoscopic]] approach is superior with fewer [[surgical]] complications in comparison to [[craniotomy]] and [[shunting]],<ref>Lee, Yun Ho, Young Sub Kwon, and Kook Hee Yang. "Multiloculated Hydrocephalus: Open Craniotomy or Endoscopy?." ''Journal of Korean Neurosurgical Society'' 60.3 (2017): 301.</ref> | ||
* Regarding symptoms, endoscopic approach has been preferred with hydrocephalus as this allows more space to execute the surgery.<ref name=":0">Mustansir, Fatima, Sanaullah Bashir, and Aneela Darbar. "Management of arachnoid cysts: A comprehensive review." ''Cureus'' 10.4 (2018).</ref> | * Regarding symptoms, [[endoscopic]] approach has been preferred with [[hydrocephalus]] as this allows more space to execute the surgery.<ref name=":0">Mustansir, Fatima, Sanaullah Bashir, and Aneela Darbar. "Management of arachnoid cysts: A comprehensive review." ''Cureus'' 10.4 (2018).</ref> | ||
* Location of the cyst also plays an important role on choosing the approach and possible outcomes: | * Location of the cyst also plays an important role on choosing the approach and possible outcomes: | ||
** Middle cranial fossa: endoscopy is still controversial; microsurgery may be a better option in this location.<ref name=":0" /> | **[[Middle cranial fossa]]: [[endoscopy]] is still controversial; [[microsurgery]] may be a better option in this location.<ref name=":0" /> | ||
*** Type I - microsurgical fenestration; | *** Type I - microsurgical [[Fenestrations|fenestration]]; | ||
*** Type II - endoscopic cystocisternotomy, if it fails: microsurgical fenestration or shunting; | *** Type II - [[Endoscopic surgery|endoscopic]] [[cystocisternotomy]], if it fails: microsurgical [[fenestration]] or [[shunting]]; | ||
*** Type III - endoscopic cystocisternotomy, if it fails: microsurgical fenestration or shunting; | *** Type III - [[Endoscopic surgery|endoscopic]] [[cystocisternotomy]], if it fails: microsurgical [[fenestration]] or [[shunting]]; | ||
** Suprasellar: usually present with hydrocephalus - endoscopic fenestration is the | **[[Suprasellar]]: usually present with [[hydrocephalus]] - [[Endoscopic surgery|endoscopic]] [[Fenestrations|fenestration]] is the preferred treatment. [[Craniotomy]] is associated with increased [[morbidity]]. [[Endoscopic surgery|Endoscopic]] [[ventriculocystocisternostomy]] preferred over [[ventriculocystostomy]].<ref name=":0" /> | ||
** Interhemispheric: may be: | **[[Interhemispheric]]: may be: | ||
*** Parasagittal: excision of the cyst; | *** Parasagittal: excision of the cyst; | ||
*** Midline: associated with agenesis of the | *** Midline: associated with [[agenesis of the corpus callosum]], [[fenestration]] is preferred. | ||
** Quadrigeminal: | **[[Quadrigeminal plate|Quadrigeminal]]: | ||
*** Type I - Supratentorial | *** Type I - [[Supratentorial]] | ||
*** Type II - Infratentorial: | *** Type II - [[Infratentorial]]: | ||
*** Type III - lateral extension toward the temporal lobe. May present with symptoms such as headaches, vomiting, lethargy, and impairment of upward gaze, macrocrania. If symptomatic, they must be treated | *** Type III - lateral extension toward the [[temporal lobe]]. May present with symptoms such as [[headaches]], [[vomiting]], [[lethargy]], and [[impairment of upward gaze]], [[macrocrania]]. If [[symptomatic]], they must be treated | ||
**** Endoscopic method is preferred for all of them due to the proximity with the pineal region. | ****[[Endoscopic]] method is preferred for all of them due to the proximity with the [[pineal]] region.<ref name=":0" /> | ||
==References== | ==References== | ||
Latest revision as of 02:28, 30 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]
Overview
Treatment for arachnoid cysts occurs when symptoms present themselves. A variety of surgical procedures may be used to decompress (remove pressure from) the cyst.
Surgery
- There are a number of approaches in treating arachnoid cysts, the most common are:
- Endoscopic fenestration and removal of the cyst wall (advances in neurosurgical techniques favor fenestration over shunt insertion as the preferred method for initial management).[1]
- Microsurgical fenestration;
- Craniotomy followed by shunting.
- Neuroradiology imaging is needed to assess: location of the cyst and its size;
- It is still a controversy which is the best method, some studies state that the fenestration is associated with more complications[2] while some argue that the endoscopic approach is superior with fewer surgical complications in comparison to craniotomy and shunting,[3]
- Regarding symptoms, endoscopic approach has been preferred with hydrocephalus as this allows more space to execute the surgery.[4]
- Location of the cyst also plays an important role on choosing the approach and possible outcomes:
- Middle cranial fossa: endoscopy is still controversial; microsurgery may be a better option in this location.[4]
- Type I - microsurgical fenestration;
- Type II - endoscopic cystocisternotomy, if it fails: microsurgical fenestration or shunting;
- Type III - endoscopic cystocisternotomy, if it fails: microsurgical fenestration or shunting;
- Suprasellar: usually present with hydrocephalus - endoscopic fenestration is the preferred treatment. Craniotomy is associated with increased morbidity. Endoscopic ventriculocystocisternostomy preferred over ventriculocystostomy.[4]
- Interhemispheric: may be:
- Parasagittal: excision of the cyst;
- Midline: associated with agenesis of the corpus callosum, fenestration is preferred.
- Quadrigeminal:
- Type I - Supratentorial
- Type II - Infratentorial:
- Type III - lateral extension toward the temporal lobe. May present with symptoms such as headaches, vomiting, lethargy, and impairment of upward gaze, macrocrania. If symptomatic, they must be treated
- Endoscopic method is preferred for all of them due to the proximity with the pineal region.[4]
- Middle cranial fossa: endoscopy is still controversial; microsurgery may be a better option in this location.[4]
References
- ↑ Pradilla, Gustavo, and George Jallo. "Arachnoid cysts: case series and review of the literature." Neurosurgical focus 22.2 (2007): 1-4.
- ↑ Choi, Jung Won, et al. "Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children." Child's Nervous System 31.1 (2015): 77-86.
- ↑ Lee, Yun Ho, Young Sub Kwon, and Kook Hee Yang. "Multiloculated Hydrocephalus: Open Craniotomy or Endoscopy?." Journal of Korean Neurosurgical Society 60.3 (2017): 301.
- ↑ 4.0 4.1 4.2 4.3 Mustansir, Fatima, Sanaullah Bashir, and Aneela Darbar. "Management of arachnoid cysts: A comprehensive review." Cureus 10.4 (2018).