Arachnoid cyst surgery
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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 (best approach to perform an opening which should be at least 10-15mm wide with a subsequent removal of the cyst wall);
- 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[1] while some argue that the endoscopic approach is superior with fewer surgical complications in comparison to craniotomy and shunting,[2]
- Regarding symptoms, endoscopic approach has been preferred with hydrocephalus as this allows more space to execute the surgery.[3]
- 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.[3]
- 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 preffered treatment. Craniotomy is associated with increased morbidity. Endoscopic ventriculocystocisternostomy preferred over ventriculocystostomy.[3]
- Interhemispheric: may be:
- Parasagittal: excision of the cyst;
- Midline: associated with agenesis of the corpo 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.
- Middle cranial fossa: endoscopy is still controversial; microsurgery may be a better option in this location.[3]
References
- ↑ 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.
- ↑ 3.0 3.1 3.2 Mustansir, Fatima, Sanaullah Bashir, and Aneela Darbar. "Management of arachnoid cysts: A comprehensive review." Cureus 10.4 (2018).