Arachnoid cyst surgery

Revision as of 00:52, 30 June 2020 by Jose Loyola (talk | contribs)
Jump to navigation Jump to search

Arachnoid cyst Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Classification

Causes

Differentiating Arachnoid cyst from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Diagnostic Study of Choice

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Arachnoid cyst surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Arachnoid cyst surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Arachnoid cyst surgery

CDC on Arachnoid cyst surgery

Arachnoid cyst surgery in the news

Blogs on Arachnoid cyst surgery

Directions to Hospitals Treating Arachnoid cyst

Risk calculators and risk factors for Arachnoid cyst surgery

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.

References

  1. 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.
  2. 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. 3.0 3.1 3.2 Mustansir, Fatima, Sanaullah Bashir, and Aneela Darbar. "Management of arachnoid cysts: A comprehensive review." Cureus 10.4 (2018).