Fiberscopic Fenestration and Prophylactic Stenting of Periaqueductal Cysts. Technical Report on Three Cases

Abstract

The authors report on three consecutive cases of periaqueductal cysts, causing non-communicating hydrocephalus, successfully treated with endoscopic fenestration and aqueductal stenting. Navigation and cyst fenestration were accomplished using a slim (1.1 mm outside diameter) optic fiberscope inserted via a precoronal-paramedian burr hole. Third ventriculostomy was also performed after cyst fenestration in two cases. Because of the lack of data regarding such lesions and the possible recurrence with simple fenestration, an aqueductal stent connected to a subcutaneous reservoir was placed, in all 3 cases, under direct visualization. Average duration of the procedure was less than sixty minutes and there were no intra- or perioperative complications. All patients recovered clinically and their postoperative neuroimaging assessment confirmed a decrease in size of both the ventricular system and cyst (mean follow-up: 6.8 months). The authors conclude than this minimally invasive procedure is a promising, safe and effective method to treat cerebral symptomatic periaqueductal cysts and associated non-communicating hydrocephalus.

Key words

Aqueductal cyst - endoscopic fenestration - stent

References

• 1 Harsh G R, Edwards M SB, Wilson C B. Intracranial arachnoid cysts in children.  J Neurosurg. 1986;  64 835-842
• 2 Basauri L, Selman J M. Intracranial arachnoidal cysts.  Child Nerv Syst. 1992;  8 101-104
• 3 Hanieh A, Simpson D A, North J B. Arachnoid cysts: a critical review of 41 cases.  Child Nerv Syst. 1988;  4 92-96
• 4 Navase H, Hisanaga M, Hashimoto S, Imanichi M, Utsumi S. Intraventricular arachnoid cyst: report of two cases.  J Neurosurg. 1988;  68 482-486
• 5 Goda K, Tsoumada S, Akaka T, Nikes H, Yoshimura Y, Sato N, Nakagawa H, Iwasaki S. Intraventricular arachnoid cyst appearing with attacks of orbital pain: case report and review of the literature.  No Shinkei Geka. 1990;  18 757-760
• 6 Okamura K, Watanabe M, Inoue N, Kanoh M, Ohno T, Mitsui Y, Wakabayashi K. Intraventricular arachnoid cyst: on the origin of intraventricular arachnoid cysts.  No To Shinkei. 1996;  48 1015-1021
• 7 Pelletier J, Milandre L, Peragut J C, Cronqvist S. Intraventricular choroid plexus “arachnoid” cyst. MRI findings.  Neuroradiology. 1990;  32 523-525
• 8 Seike M, Kurisaka M, Mori K. Intraventricular arachnoid cyst.  Neurol Med Chir. 1987;  27 154-158
• 9 Yeates A, Enzmann D. An intraventricular arachnoid cyst.  J Comput Assist Tomogr. 1979;  3 697-700
• 10 Acar O, Kocaogullar Y, Guney O. Arachnoid cyst within the fourth ventricle: a case report.  Clin Neurol Neurosurg. 2003;  105 93-94
• 11 Azzimondi G, Calbucci F, Rinaldi R, Vignatelli L, D'Alessandro R. Arachnoid cyst in the region of the fourth ventricle mimicking clinical picture of normal pressure hydrocephalus.  Neurosurg Rev. 1995;  18 269-271
• 12 Makiuchi T, Kadota K, Asakura T, Uchimura K, Todoroki K, Ode R. Arachnoid cyst of the fourth ventricle. Case report.  Neurol Med Chir (Tokyo). 1990;  30 848-852
• 13 Nadkarni T, Rande A, Nagpal R. Arachnoid cyst within the fourth ventricle: a case report.  Br J Neurosurg. 1995;  9 675-678
• 14 Tamburus W M, Brock M, Wolter M. Arachnoid cyst of the 3d ventricle: report of 2 cases.  Arq Neuropsiquiatr. 1987;  45 295-301
• 15 Turgut M, Ozcan O E, Onol B. Case report and review of the literature: arachnoid cyst of the fourth ventricle presenting as a syndrome of normal pressure hydrocephalus.  J Neurosurg Sci. 1992;  36 55-57
• 16 Vlaho S, Gebhardt B, Gerlach R, Weidauer S, Kieslich M. Cyst of the third ventricle as an unusual cause of acquired hydrocephalus.  Pediatr Neurol. 2003;  28 225-227
• 17 Shin M, Nishihara T, Iai S, Eguchi T. Benign aqueductal cyst causing bilateral internuclear ophthalmoplegia after external ventricular drainage. Case report.  J Neurosurg. 2000;  92 490-492
• 18 Martinez-Lage J F, Poza M, Sola J. et al . Congenital arachnoid cyst of the lateral ventricle in children.  Child Nerv Syst. 1992;  8 203-206
• 19 Oberbauer R W, Haase J, Pucher R. Arachnoid cyst in children: a European co-operative study.  Child Nerv Syst. 1992;  8 281-286
• 20 Buxton N, Vloeberghs M, Punt J. Flexible neuroendoscopic treatment of suprasellar arachnoid cysts.  Br J Neurosurg. 1999;  13 316-318
• 21 Fitzpatrick M O, Barlow P. Endoscopic treatment of prepontine arachnoid cysts.  Br J Neurosurg. 2001;  15 234-238
• 22 Maiuri F, Iaconetta G, Gangemi M. Arachnoid cyst of the lateral ventricle.  Surg Neurol. 1997;  48 401-404
• 23 Schroeder H W, Gaab M R, Niendorf W R. Neuroendoscopic approach to arachnoid cysts.  J Neurosurg. 1996;  85 293-298
• 24 Fritsch M J, Kienke S, Mehdorn H M. Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children.  Neurosurg. 2004;  55 372-379
• 25 Rekate H L. Brain turgor (KB): Intrinsic property of the brain to resist distortion.  Pediatr Neurosurg. 1992;  18 257-262
• 26 Cinalli G, Sainte Rose C, Simon I, Lot G, Sgouros S. Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction.  J Neurosurg. 1999;  90 227-236
• 27 Schroeder H W, Gaab M R. Endoscopic aqueductoplasty: technique and results.  Neurosurgery. 1999;  45 508-515
• 28 Bulsara K R, Villavicencio A T, Shah A J, McGirt M J, George T M. Successful aqueductal plasty and stenting for tectal plate tumor after failed third ventriculostomy: a case report.  Surg Neurol. 2003;  59 58-61
• 29 Fritsch M J, Kienke S, Mehdom H M. Endoscopic aqueductoplasty: stent or not to stent?.  Childs Nerv Syst. 2004;  20 137-142
• 30 Shin M, Morita A, Asano S, Ueki K, Kirino T. Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement. Case report.  J Neurosurg. 2000;  92 1036-1039
• 31 Furuta S, Hatakeyama T, Nishizaki O. et al . Usefulness of neuroendoscopy in treating supracollicular arachnoid cysts. Case report.  Neurol Med Chir. 1998;  38 107-109