Endoscopic fenestration for treating Galassi type III middle cranial fossa arachnoid cysts: single- and multiple-stoma have the same curative effect

Background and Study Aims For endoscopic fenestration of middle cranial fossa arachnoid cysts (MCFACs), the decisions on the location and number of stomas are key issues in the operation. However, research on this particular topic has been limited. Thus, this study aimed to compare single-stoma versus multiple-stoma endoscopic fenestration for treating Galassi type III MCFACs. Patients and Methods This retrospective study included 86 patients with Galassi type III MCFACs treated with endoscopic fenestration. Single-stoma fenestration to the basal cistern was performed in 37 cases, while multiple-stoma fenestration to the basal cistern and the carotid cistern was performed in 49 cases. Clinico-radiological profiles and follow-up data were analyzed. Results The rate of symptom relief was 83.7%(72/86), and the rate of cyst shrinkage was 96.5%(83/86). Postoperative ipsilateral subdural effusion, which was significant(P=0.042), and non-infectious fever were the two most common complications in the single-stoma and multiple-stoma groups. No significant differences in intraoperative nerve injury, vascular injury, proportion of cases with cyst reduction, and symptom remission rate were observed between both groups. The rates of cyst recurrence and secondary surgery in the single-stoma group were higher than those in the multiple-stoma group, although the difference was not significant. Conclusion Endoscopic fenestration is an effective and minimally invasive approach for treating Galassi type III MCFACs. Single-stoma and multiple-stoma have the same curative effect.

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Arachnoid cysts

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0096 ◽

2019 ◽

pp. 1101-1106

Author(s):

Ruichong Ma ◽

Stana Bojanic

Keyword(s):

Cerebral Spinal Fluid ◽

Spinal Column ◽

Middle Cranial Fossa ◽

Paediatric Population ◽

Arachnoid Cysts ◽

Arachnoid Membrane ◽

Head Growth ◽

Asymptomatic Patients ◽

Cranial Fossa ◽

Endoscopic Fenestration

First described in 1831, arachnoid cysts are cerebral spinal fluid-filled spaces lined with arachnoid membrane. They account for 1% of all intracranial space occupying lesions and can also be found rarely in the spinal column. Most intracranial arachnoid cysts are found in the middle cranial fossa with a male predilection and a slight preponderance for the left side. With the availability of modern imaging, many more arachnoid cysts are being picked up incidentally in asymptomatic patients. However, symptomatic arachnoid cysts are predominantly found in the paediatric population with patients typically presenting with headaches, rapid head growth, developmental delay, and seizures. Treatment of patients with asymptomatic arachnoid cysts has typically been conservative management with surgery only considered in patients with symptoms. Surgical management remains controversial and includes open techniques, endoscopic fenestration of cyst, or shunting procedures.

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Endoscopic fenestration of middle cranial fossa arachnoid cysts: Does size matter?

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2010.10.006 ◽

2011 ◽

Vol 18 (5) ◽

pp. 607-612 ◽

Cited By ~ 14

Author(s):

Reuben D. Johnson ◽

Sara Chapman ◽

Stana Bojanic

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Cranial Fossa ◽

Size Matter ◽

Endoscopic Fenestration

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Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children

Child s Nervous System ◽

10.1007/s003810050024 ◽

2000 ◽

Vol 16 (2) ◽

pp. 111-116 ◽

Cited By ~ 54

Author(s):

J. -K. Kang ◽

K. S. Lee ◽

I. W. Lee ◽

S. S. Jeun ◽

B. C. Son ◽

...

Keyword(s):

Surgical Treatment ◽

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Cranial Fossa

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CT SCAN AND METRIZAMIDE CT CISTERNOGRAPHY IN ARACHNOID CYSTS OF THE MIDDLE CRANIAL FOSSA

Journal of Computer Assisted Tomography ◽

10.1097/00004728-198212000-00056 ◽

1982 ◽

Vol 6 (6) ◽

pp. 1226

Author(s):

E. Galassi ◽

E. Tognetti ◽

G. Gaist ◽

L. Fagioli ◽

F. Frank ◽

...

Keyword(s):

Ct Scan ◽

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Ct Cisternography ◽

Cranial Fossa ◽

Metrizamide Ct Cisternography

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Arachnoid cysts of the middle cranial fossa: a consideration of their origins based on imaging

Neuroradiology ◽

10.1007/bf00588369 ◽

1993 ◽

Vol 35 (5) ◽

pp. 355-358 ◽

Cited By ~ 25

Author(s):

J. M. Garc�a Santos ◽

J. Mart�nez-Lage ◽

A. Gilabert Ubeda ◽

A. Capel Alem�n ◽

V. Climent Oltr�

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Cranial Fossa

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Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting

Journal of Neurosurgery ◽

10.3171/jns.1991.74.2.0230 ◽

1991 ◽

Vol 74 (2) ◽

pp. 230-235 ◽

Cited By ~ 159

Author(s):

Samuel F. Ciricillo ◽

Philip H. Cogen ◽

Griffith R. Harsh ◽

Michael S. B. Edwards

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Shunt Revision ◽

Content Type ◽

Cyst Recurrence ◽

Cranial Fossa ◽

The Subject ◽

Low Incidence ◽

Cyst Fenestration

✓ The best operative intervention for children with arachnoid cysts remains the subject of controversy. Recent reports stress that craniotomy for cyst fenestration is associated with a low incidence of morbidity and mortality and may leave the child shunt-independent. The cases of 40 pediatric patients with arachnoid cysts treated between 1978 and 1989 are reported. Five children with mild symptoms and small cysts that remained stable on follow-up studies have not required surgical intervention. Of 15 patients with cysts initially treated by fenestration, 10 (67%) showed no clinical or radiographic improvement postoperatively and have undergone cyst-peritoneal (eight patients) or ventriculoperitoneal (VP) shunting (one patient), or revision of a VP shunt placed for hydrocephalus before cyst fenestration (one patient). Two other patients with existing VP shunts required no further procedures. Thus, only three (20%) of 15 patients initially treated by fenestration remain shunt-independent after a median follow-up period of 8 years. The 20 other patients were initially treated by cyst shunting and all improved postoperatively; shunt revision has been necessary in six (30%) of these 20 patients because of cyst recurrence, Cyst location influenced the success of shunt treatment; none of the seven middle cranial fossa cysts treated by shunting have required revision, but results with cysts in other locations were less favorable. In all locations, though, shunting was more successful than fenestration. It is concluded that cyst-peritoneal or cyst-VP shunting is the procedure of choice for arachnoid cysts in most locations, including those in the middle cranial fossa.

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Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and non-progressive symptoms.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.46.12.1102 ◽

1983 ◽

Vol 46 (12) ◽

pp. 1102-1107 ◽

Cited By ~ 67

Author(s):

F G van der Meche ◽

R Braakman

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Cranial Fossa

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Arachnoid cyst slit valves: the mechanism for arachnoid cyst enlargement

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.4.peds12609 ◽

2013 ◽

Vol 12 (1) ◽

pp. 62-66 ◽

Cited By ~ 26

Author(s):

Sameer H. Halani ◽

Mina G. Safain ◽

Carl B. Heilman

Keyword(s):

Arachnoid Cyst ◽

Basilar Artery ◽

Cardiac Cycle ◽

Mass Effect ◽

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Csf Flow ◽

Subdural Hygroma ◽

Cranial Fossa ◽

Mass Lesions

Arachnoid cysts are common, accounting for approximately 1% of intracranial mass lesions. Most are congenital, clinically silent, and remain static in size. Occasionally, they increase in size and produce symptoms due to mass effect or obstruction. The mechanism of enlargement of arachnoid cysts is controversial. One-way slit valves are often hypothesized as the mechanism for enlargement. The authors present 4 cases of suprasellar prepontine arachnoid cysts in which a slit valve was identified. The patients presented with hydrocephalus due to enlargement of the cyst. The valve was located in the arachnoid wall of the cyst directly over the basilar artery. The authors believe this slit valve was responsible for the net influx of CSF into the cyst and for its enlargement. They also present 1 case of an arachnoid cyst in the middle cranial fossa that had a small circular opening but lacked a slit valve. This cyst did not enlarge but surgery was required because of rupture and the development of a subdural hygroma. One-way slit valves exist and are a possible mechanism of enlargement of suprasellar prepontine arachnoid cysts. The valve was located directly over the basilar artery in each of these cases. Caudad-to-cephalad CSF flow during the cardiac cycle increased the opening of the valve, whereas cephalad-to-caudad CSF flow during the remainder of the cardiac cycle pushed the slit opening against the basilar artery and decreased the size of the opening. Arachnoid cysts that communicate CSF via circular, nonslit valves are probably more likely to remain stable.

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Endoscopic treatment of middle cranial fossa arachnoid cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.12.peds11298 ◽

2012 ◽

Vol 9 (3) ◽

pp. 231-238 ◽

Cited By ~ 26

Author(s):

Nasser M. F. El-Ghandour

Keyword(s):

Middle Cranial Fossa ◽

Arachnoid Cysts ◽

Cyst Size ◽

Intraoperative Bleeding ◽

Initial Surgery ◽

Significant Clinical Improvement ◽

Recovery Times ◽

Cranial Fossa

Object Arachnoid cysts located in the middle cranial fossa are common, comprising about half of all intracranial arachnoid cysts. The management of these cysts is challenging, and the optimal surgical treatment is controversial. This study evaluates the role of endoscopy in the treatment of middle cranial fossa arachnoid cysts (MCFACs) in children, focusing on some factors or technical aspects that might influence the outcome. Methods Thirty-two children with symptomatic MCFACs were the subject of this study. The group included 23 boys and 9 girls, with a mean age of 3.6 years. All patients underwent operations using a purely endoscopic cystocisternostomy procedure through a transtemporal approach. Results Significant clinical improvement occurred in 28 cases (87.5%). Postoperative MR imaging showed a reduction in cyst size in 23 cases (71.9%), whereas in the remaining 9 cases (28.1%), the cyst size was unchanged. Minor intraoperative bleeding occurred in 3 cases (9.4%), which stopped spontaneously without any postoperative sequelae. Ipsilateral subdural hygroma occurred in 2 cases (6.3%) and resolved within a few weeks without surgery; transient oculomotor palsy occurred in 1 case (3.1%). During follow-up (mean 4.6 years), 3 patients (9.4%) experienced recurrence of symptoms and an increase in cyst size. Interestingly, all 3 patients who had recurrence had also experienced intraoperative bleeding at initial surgery. At a second endoscopic procedure, the fenestration was found to be closed in all 3 patients. Conclusions Endoscopic cystocisternostomy is recommended in the treatment of MCFACs in children because it is simple, minimally invasive, and effective. It maintains the basic strategy of cyst fenestration into the basal cisterns without the invasiveness of open craniotomy. This procedure reduces operative and recovery times and is associated with low morbidity and mortality rates.

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