Endoscopic treatment of intraparenchymal arachnoid cysts in children

2014 ◽  
Vol 14 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Nasser M. F. El-Ghandour
Keyword(s):  
Subarachnoid Space ◽  
Brain Parenchyma ◽  
Arachnoid Cysts ◽  
Third Ventriculostomy ◽  
Cyst Size ◽  
Significant Clinical Improvement ◽  
Recovery Times ◽  
Intracranial Lesions ◽  
Ventricle Size ◽  
Basal Cisterns

Object Arachnoid cysts account for 1% of all intracranial lesions. They usually occur in the subarachnoid space of the major cerebral fissures and arachnoid cisterns. They are very rarely located within the brain parenchyma devoid of communication with the subarachnoid space. The author of this study evaluated the role of endoscopy in the treatment of intraparenchymal arachnoid cysts (IPACs), which have a paraventricular location noncontiguous with the basal cisterns. Methods The records of all patients who had undergone surgery performed by one neurosurgeon between March 2004 and October 2011 were retrospectively reviewed to find cases of arachnoid cysts with a paraventricular location noncontiguous with the basal cisterns that were treated with a purely endoscopic cystoventriculostomy. Data were collected, summarized, and analyzed as regards improvement in symptomatology, decrease in cyst size, improvement in hydrocephalus, incidence of complications, surgical failure, and incidence of recurrence. Results Twelve pediatric patients with symptomatic IPACs were included in this study. The group included 7 boys and 5 girls with a mean age of 5.2 years. All of the patients had undergone endoscopic cystoventriculostomy. In addition, endoscopic third ventriculostomy had been performed during the same operative session in 3 patients who had associated hydrocephalus. Significant clinical improvement occurred in 10 patients (83.3%). Postoperative imaging showed a reduction in the cyst size in 9 patients (75%), whereas the cyst size was unchanged in the remaining 3 patients (25%). A reduction in ventricle size occurred in 2 (66.7%) of the 3 patients who had hydrocephalus. A postoperative subdural hygroma occurred in 2 patients (16.7%) and required the insertion of a subduroperitoneal shunt in 1 patient. During the follow-up period (mean 42.5 months), 1 patient had a recurrence and required a repeat endoscopic procedure. Conclusions Endoscopic cystoventriculostomy is recommended in the treatment of symptomatic IPACs. It maintains the basic strategy of cyst fenestration into the lateral ventricle without either the invasiveness of open craniotomy or the implantation of shunt systems. The procedure is simple, effective, and minimally invasive. It saves operative and recovery times and is associated with low morbidity and mortality rates.

Endoscopic treatment of middle cranial fossa arachnoid cysts in children

2012 ◽  
Vol 9 (3) ◽  
pp. 231-238 ◽  
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.

Endoscopic treatment of quadrigeminal arachnoid cysts in children

2013 ◽  
Vol 12 (5) ◽  
pp. 521-528 ◽  
Author(s):  
Nasser M. F. El-Ghandour
Keyword(s):  
Surgical Treatment ◽  
Endoscopic Treatment ◽  
Endoscopic Procedure ◽  
Arachnoid Cysts ◽  
Third Ventriculostomy ◽  
Cyst Size ◽  
Shunt Placement ◽  
Postoperative Mri ◽  
Quadrigeminal Cistern ◽  
First Choice

Object Quadrigeminal arachnoid cysts (QACs) are rare, comprising approximately 5%–10% of all intracranial arachnoid cysts. The management of these cysts is challenging, and their optimal surgical treatment is controversial. This study evaluates the role of endoscopy in the treatment of QACs in children, focusing on some factors or technical aspects that might influence the outcome. Methods Eighteen children with symptomatic QACs were the subject of this study. The group included 10 boys and 8 girls, with a mean age of 2.5 years. All patients had hydrocephalus. Surgical treatment included ventriculocystostomy (14 cases), endoscopic third ventriculostomy (14 cases), ventriculocystocisternostomy (2 cases), cystocisternostomy (2 cases), and removal of preexisting malfunctioning cystoperitoneal shunt (4 cases). Results Significant clinical improvement occurred in 15 cases (83.3%). Postoperative MRI showed a reduction in the cyst size in 14 cases (77.8%), whereas in the remaining 4 cases (22.2%) the cyst size was unchanged. A postoperative decrease in ventricular size was encountered in 16 cases (88.9%). Minor intraoperative bleeding occurred in 1 case (5.6%), which stopped spontaneously without any postoperative sequelae. Postoperative subdural hygroma occurred in 3 cases (16.7%) and required a subduroperitoneal shunt in 2 cases. During follow-up (mean 45.8 months), a repeat endoscopic procedure was performed in 7 patients (all 4 patients with a prior shunt and 3 patients without a prior shunt), and new shunt placement was required in 5 patients (all 4 patients with a prior shunt and 1 patient without a prior shunt). Thus, none of the patients with a prior shunt was able to become shunt independent, whereas 92.9% of patients without a prior shunt were able to avoid shunt placement. Conclusions Arachnoid cysts of the quadrigeminal cistern and the associated hydrocephalus can be effectively treated by endoscopy. The procedure is simple, minimally invasive, and associated with low morbidity and mortality rates. The fact that all patients who previously received shunts required a repeat endoscopic procedure and that none of these patients was able to become shunt independent makes it clear that endoscopic treatment should be considered the first choice in the management of patients with arachnoid cysts in the quadrigeminal cistern.

scholarly journals Intraparenchymal supratentorial arachnoid cyst: a case report

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Domagoj Dlaka ◽  
Marina Raguž ◽  
Danko Muller ◽  
Dominik Romić ◽  
Fadi Almahariq ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Subarachnoid Space ◽  
Clinical Symptoms ◽  
Arachnoid Cysts ◽  
Anatomical Location ◽  
Left Frontal Lobe ◽  
Case Presentation ◽  
Intracranial Lesions ◽  
Anatomic Distribution ◽  
Surgical Treatments

Abstract Background Intracranial arachnoid cysts are collections of cerebrospinal fluid within the arachnoid membrane and subarachnoid space of the cisterns and major cerebral fissures that account for about 1% of all intracranial lesions. Expansion of the cyst and compression on surrounding structures may became symptomatic, which reflects its size and anatomic distribution. Case presentation Here, we present a very rare case of patient with supratentorial intraparenchymal arachnoid cyst placed in the left frontal lobe without any communication with the subarachnoid space and ventricle and presented with clinical symptoms. The patient underwent fenestration of the lesion and was clinically improved. Conclusions Although the etiology and the enlargement mechanism of arachnoid cysts remain unclear, both conservative and surgical treatments are optional. According to size, anatomical location, neuroimaging, and clinical symptoms, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.

Elastance Correlates with Outcome after Endoscopic Third Ventriculostomy in Adults with Hydrocephalus Caused by Primary Aqueductal Stenosis

Neurosurgery ◽  
2002 ◽  
Vol 50 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Magnus Tisell ◽  
Mikael Edsbagge ◽  
Hannes Stephensen ◽  
Marek Czosnyka ◽  
Carsten Wikkelsø
Keyword(s):  
Clinical Improvement ◽  
Subarachnoid Space ◽  
Clinical Effect ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Shunt Operation ◽  
Shunt Surgery ◽  
Ventricle Size ◽  
Excellent Improvement

ABSTRACT OBJECTIVE To study prospectively the correlation between clinical outcome after endoscopic third ventriculostomy (ETV) and resistance to the outflow of cerebrospinal fluid (Rout) and elastance in adults with hydrocephalus caused by primary aqueductal stenosis (AS). METHODS Rout and elastance were measured in the subarachnoid space and intraventricularly before ETV in 15 consecutive patients. Three months after the ETV, the clinical effect was evaluated by standardized indices, and Rout and elastance were measured. If symptoms persisted and the ETV was patent, shunt surgery was offered. The effect of the shunt operation and Rout were measured after 3 months. RESULTS Four patients experienced excellent improvement, six improved slightly, and five had unchanged or deteriorated symptoms after ETV. Rout before ETV did not correlate with outcome. Rout decreased after ETV with correlation to the clinical effect; in the six patients who had shunt surgery, Rout decreased further. High preoperative elastance correlated strongly with a good outcome and reduction of ventricle size. Elastance did not change after ETV. CONCLUSION Rout intraventricularly and in the subarachnoid space could not predict the outcome of the ETV, but the reduction in Rout correlated positively with clinical improvement. Preoperative elastance correlated positively with clinical improvement, and elastance was unchanged after ETV. Clinical improvement correlated positively with reduction in ventricle size.

Experimental Third Ventriculostomy Performed Using Endovascular Surgical Techniques and Their Adaptation to Percutaneous Intradural Neuronavigation: Proof of Concept Cadaver Study

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 387-392 ◽  
Author(s):  
Michael B. Horowitz ◽  
Kamal Ramzipoor ◽  
Ajit Nair ◽  
Susan Miller ◽  
George Rappard ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Surgical Techniques ◽  
Cadaver Study ◽  
Brain Parenchyma ◽  
Third Ventriculostomy ◽  
General Anesthetic ◽  
The Third ◽  
Noncommunicating Hydrocephalus ◽  
Pass Through ◽  
The Brain

Abstract OBJECTIVE Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the subarachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

Transventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review

2008 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Ashish Suri ◽  
Rohit Kumar Goel ◽  
Faiz Uddin Ahmad ◽  
Ananth Kesav Vellimana ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
English Language ◽  
Third Ventriculostomy ◽  
Cyst Excision ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
The Central Nervous System ◽  
The Mean ◽  
Clinical Records ◽  
Ventricle Size

Object Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically. Methods The clinical records of 13 patients with fourth ventricular NCC who had presented with hydrocephalus were retrospectively analyzed. A fourth ventricular cyst was completely excised in all patients by using a transventricular, transaqueductal “scope-in-scope” endoscopic technique. Twelve endoscopic third ventriculostomies and 1 septostomy had been performed. Results Shunt placement was avoided in all patients. There were minimal peri- and postoperative complications. The mean duration of follow-up was 22.3 months (range 3–41 months). All patients had an improved clinical outcome. Follow-up neuroimaging revealed no residual lesion and a decreased ventricle size in all patients. Conclusions The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.

scholarly journals Neuropsychological Outcome after Endoscopic Third Ventriculostomy

2014 ◽  
Vol 41 (6) ◽  
pp. 729-734 ◽  
Author(s):  
Walter J. Hader ◽  
Brian L. Brooks ◽  
Lisa Partlo ◽  
Mark Hamilton
Keyword(s):  
Executive Function ◽  
Cognitive Dysfunction ◽  
Verbal Memory ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Cognitive Domain ◽  
Third Ventriculostomy ◽  
Neuropsychological Outcome ◽  
Language Functions ◽  
Ventricle Size

AbstractBackground: Cognitive dysfunction is a common complaint associated with obstructive hydrocephalus. The purpose of this study was to determine the effect of endoscopic third ventriculostomy (ETV) on the neuropsychological outcome in patients presenting with cognitive decline and obstructive hydrocephalus. Methods: A retrospective review of patients who underwent ETV at the University of Calgary and had both pre and post operative neuropsychological testing, was completed. Presenting clinical features, etiology of hydrocephalus and ventricle size utilizing frontal occipital horn ratio was obtained. Outcomes and complications of the ETV were recorded. Detailed measures of intelligence, attention and concentration, executive function, visual and verbal memory, language functions and fine motor skills were completed. Post treatment change was determined utilizing Reliable Change Index. Results: A total of 13 patients were identified. Etiology of the hydrocephalus was aqueductal stenosis in 8 and tectal glioma in 4. The majority of patients (11 of 13, 85%) demonstrated cognitive dysfunction at the borderline (≤1 SD) or impairment level (≤1.5 SDs) in at least one domain. Nine patients (69%) showed reliable improvement in at least one cognitive domain. The greatest improvement was seen with visual memory (42%). One quarter to one third of patients demonstrated improvement on tests of intelligence quotient, verbal memory, attention and concentration, and executive function. Two patients declined in executive functioning. Ventricle size improved in eight patients. Conclusions: ETV is a safe effective procedure, capable of producing reliable improvements in cognitive dysfunction with hydrocephalus. Patients with cognitive complaints alone may benefit from ETV.

scholarly journals The False Falx and Tentorium Sign: Case Report of Subdural Haematoma and Sickle Cells Disease

2014 ◽  
Vol 21 (3) ◽  
pp. 331-335
Author(s):  
Hernando Raphael Alvis-Miranda ◽  
Carlos Fernando Lozano-Tangua ◽  
Gabriel Alcala-Cerra ◽  
Andres M. Rubiano ◽  
Luis Rafael Moscote-Salazar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subarachnoid Space ◽  
Subdural Haematoma ◽  
Contrast Material ◽  
Ct Scans ◽  
Cell Disease ◽  
Intravenous Contrast ◽  
Sickle Cells ◽  
High Doses ◽  
Basal Cisterns

Abstract The increased density in the basal cisterns and the subarachnoid space on CT scans is a well-known characteristic of subarachnoid hemorrhage. Have been described diverse conditions that can emulate subarachnoid hemorrhage, such as purulent leptomeningitis, intrathecal contrast material and leak of high doses of intravenous contrast material to the subarachnoid space. We present the case of a male patient who presented a subdural hematoma in the setting of non-diagnosed sickle cell disease. To this patient was performed a panangiography which discard any aneurismal hemorrhage origin

One- vs Two-Burr-Hole Technique for Combined Endoscopic Third Ventriculostomy and Pineal Region Biopsy: Volumetric Analysis of Brain at Risk

2020 ◽  
Vol 19 (2) ◽  
pp. 175-180
Author(s):  
Brandon D Liebelt ◽  
Fangxiang Chen ◽  
Antonio Biroli ◽  
Xiaochun Zhao ◽  
Peter Nakaji
Keyword(s):  
At Risk ◽  
Endoscopic Third Ventriculostomy ◽  
Brain Parenchyma ◽  
Pineal Region ◽  
Burr Hole ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Burr Holes ◽  
The Brain ◽  
The Ideal

Abstract BACKGROUND Pineal region tumors are associated with the ventricular system. Endoscopic third ventriculostomy (ETV) is often performed at the same time as tumor biopsy. OBJECTIVE To investigate the volume of brain possibly undergoing injury and forniceal stretching during ETV and tumor biopsy. METHODS We performed a retrospective review of preoperative magnetic resonance imagings (MRIs) and computed tomography (CTs) of patients with pineal region masses and used volumetric image-guided navigation to simulate a 1-burr-hole vs a 2-burr-hole approach through the brain parenchyma. We compared the volumes of parenchyma and fornix at the risk of injury. RESULTS The ideal entry point for ETV using 2 burr holes was a mean ± standard deviation (SD) of 25.8 ± 6 mm from the midline and 11.4 ± 9 mm behind the coronal suture. The ideal entry point using 2 burr holes for tumor biopsy was 25.7 ± 8 mm from the midline and 53.7 ± 14 mm anterior to the coronal suture. With 1 burr hole, the mean ± SD volume of brain parenchyma at risk was 852 ± 440 mm3. The volume of brain parenchyma at risk with 2 burr holes was 2159 ± 474 mm3 (P < .001; paired t-test). The use of 1 burr hole predisposed the fornix to 14 ± 3 mm of possible stretch, which was minimized with the 2-burr-hole approach. CONCLUSION Using 1 burr hole for both the ETV and tumor biopsy is less likely to traumatize the brain parenchyma than using 2 burr holes. However, 1 burr hole predisposes the fornix to stretch injury. We recommend tailoring the entry to each patient according to their anatomy rather than using a 1-size-fits-all approach.

scholarly journals Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

2009 ◽  
Vol 36 (5) ◽  
pp. 643-647 ◽  
Author(s):  
Xiao Di ◽  
M. Ragab ◽  
Mark G. Luciano
Keyword(s):  
Brain Stem ◽  
Phase Contrast ◽  
Obstructive Hydrocephalus ◽  
Dynamic Mri ◽  
Magnetic Resonance Images ◽  
Third Ventriculostomy ◽  
Coronal Image ◽  
Significant Difference ◽  
The Brain ◽  
Basal Cisterns

Background:To predict success of endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus, we evaluated pre- and post- operative phase-contrast cine magnetic resonance images (PC MRI) on cerebrospinal fluid (CSF), cine flow in basal cisterns around the brain stem, and cervical medullar junction (CMJ) retrospectively.Methods:The study involved 102 patients with mean age of 36.74±23.25, and F/M = 1.55. All patients had PC MRI taken both pre- and post-operatively. A dynamic MRI video of PC MRI was reviewed at sagittal, axial, and coronal sections to determine cistern flows around the brain stem and CMJ. For quantitative analysis, quadrants were divided around midbrain axially to evaluate interpeduncular, quadrageminal, and ambient cisterns of both sides using scores of 0 to 60. Pre- and post- pontine and CMJ flows were shown in sagittal view and scored 0 to 20, and lateral cerebellopontine cisterns of both sides were measured on coronal image and scored 0 to 20.Results:No significant difference in CSF flow was seen from three individual views and total cine score, or between ETV success and failure groups by multivariate analysis of variance. Kaplan-Meier Analysis and Spearman's Correlation Test produced no relationship between MRI cine flow scores and interval period after surgery to ETV failure.Conclusion:PC MRI cine flow failed to demonstrate significant differences between successful and failed ETV groups. This indicates in addition to achieving an adequate fenestration, CSF pathways beyond the basal cisterns around the brain stem and CMJ may play an essential role in achieving ETV success.

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