Endoscopic fenestration of middle fossa arachnoid cysts: A technical description and case series

Mohamed Elhammady, Sanjiv Bhatia, John Ragheb

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Arachnoid cysts are intra-arachnoidal cerebrospinal fluid collections most frequently seen in the middle cranial fossa. The optimal method of treatment for symptomatic arachnoid cysts remains controversial and includes cyst shunting, open craniotomy and endoscopic fenestration. All these techniques, however, have been associated with the development of postoperative subdural fluid collections. We describe a new endoscopic transcortical technique that attempts to avoid this complication. Methods: Six patients with middle cranial fossa arachnoid cysts were treated with endoscopic fenestration at our institution between January 2002 and December 2005. Three cases were approached directly through the cyst, while the other 3 were approached by passing the endoscope through the rim of adjacent cortex. Results: All six endoscopic fenestrations were successful in treating the arachnoid cysts. Among the 3 patients treated via a direct cyst entry, 2 cases developed significant subdural hygromas, 1 of which required aspiration. On the other hand, 1 of the 3 cases treated using a transcortical technique developed an insignificant postoperative extra-axial collection that resolved at 3 months without intervention. Conclusion: Endoscopic fenestration is an effective treatment for symptomatic arachnoid cysts. Endoscopic fenestration via a transcortical approach attempts to minimize cerebrospinal fluid drainage into the subdural space, avoiding the development of significant postoperative extra-axial collections, while promoting flow into the basal cisterns.

Original languageEnglish
Pages (from-to)209-215
Number of pages7
JournalPediatric Neurosurgery
Volume43
Issue number3
DOIs
StatePublished - Apr 1 2007

Fingerprint

Arachnoid Cysts
Middle Cranial Fossa
Cysts
Subdural Space
Subdural Effusion
Craniotomy
Endoscopes
Cerebrospinal Fluid
Therapeutics

Keywords

  • Direct cyst approach
  • Endoscopic fenestration
  • Middle fossa arachnoid cysts
  • Subdural collections
  • Transcortical approach

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Endoscopic fenestration of middle fossa arachnoid cysts : A technical description and case series. / Elhammady, Mohamed; Bhatia, Sanjiv; Ragheb, John.

In: Pediatric Neurosurgery, Vol. 43, No. 3, 01.04.2007, p. 209-215.

Research output: Contribution to journalArticle

Elhammady, Mohamed ; Bhatia, Sanjiv ; Ragheb, John. / Endoscopic fenestration of middle fossa arachnoid cysts : A technical description and case series. In: Pediatric Neurosurgery. 2007 ; Vol. 43, No. 3. pp. 209-215.
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