Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

Abstract BACKGROUND Different conditions of the posterior fossa such as Chiari malformations, tumors, and arachnoid cysts require surgery through a suboccipital approach, for which a typical midline vertical linear incision is used. Curvilinear incisions have been carried in all other scalp regions other than the sub region for better cosmetic outcomes; a vertical curvilinear incision in the occipital and suboccipital region has not been reported. OBJECTIVE To evaluate the cosmetic value and safety of the “3 on a stick” vertical suboccipital curvilinear incision. METHODS We compared curvilinear to linear incisions, considering the scar's width, color, how conspicuous, and how well the scar could be covered by hair naturally. RESULTS Between 2010 and 2016, 68 children with Chiari I malformation were surgically intervened. The curvilinear incision was performed in 56 (82.4%) while a linear incision in 12 (17.6%) children. There were only 2 (2.9%) wound related complications (superficial dehiscences) in the curvilinear group and 1 additional dehiscence in a linear incision case. There were no neural or vascular complications. Scars were very similar among the 2 groups; both were equally conspicuous but curvilinear ones seemed to get covered better by hair. CONCLUSION The “3 on a stick” curvilinear incision of the suboccipital region is safe and allows for better hair coverage of the scar. It can be used for multiple conditions requiring a midline suboccipital or even occipital approach, such as Chiari malformations, tumors, and cysts.

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Adults posterior fossa anaplastic ependymoma, Case series and literature review

World Neurosurgery ◽

10.1016/j.wneu.2021.11.074 ◽

2021 ◽

Author(s):

Huang-I Hsu ◽

Shu-Shong Hsu ◽

Wen-Yuh Chung ◽

Chi-Man Yip ◽

Su-Hao Liu ◽

...

Keyword(s):

Literature Review ◽

Posterior Fossa ◽

Case Series ◽

Anaplastic Ependymoma

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Outcome of 12 antenatally diagnosed fetal arachnoid cysts: Case series and review of the literature

European Journal of Paediatric Neurology ◽

10.1016/j.ejpn.2014.12.008 ◽

2015 ◽

Vol 19 (2) ◽

pp. 114-121 ◽

Cited By ~ 22

Author(s):

B. De Keersmaecker ◽

P. Ramaekers ◽

F. Claus ◽

I. Witters ◽

E. Ortibus ◽

...

Keyword(s):

Case Series ◽

Arachnoid Cysts ◽

Review Of The Literature

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Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.2.peds10457 ◽

2011 ◽

Vol 7 (5) ◽

pp. 549-556 ◽

Cited By ~ 7

Author(s):

Daniel H. Fulkerson ◽

Todd D. Vogel ◽

Abdul A. Baker ◽

Neal B. Patel ◽

Laurie L. Ackerman ◽

...

Keyword(s):

Posterior Fossa ◽

Arachnoid Cyst ◽

Arachnoid Cysts ◽

Morbidity Rate ◽

Initial Symptom ◽

Salvage Procedure ◽

The Third ◽

First Line Therapy ◽

Posterior Fossa Cyst

Object The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts. Methods The authors performed a retrospective review of 79 consecutive patients (1993–2010) with surgically treated intracranial arachnoid cysts. Results The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years. Conclusions Posterior fossa cyst–ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.

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Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1728766 ◽

2021 ◽

Author(s):

Prashant Raj Singh ◽

Raghvendra Kumar Sharma ◽

Jitender Chaturvedi ◽

Nitish Nayak ◽

Anil Kumar Sharma

Keyword(s):

Posterior Fossa ◽

Surgical Outcome ◽

Karnofsky Performance Status ◽

Obstructive Hydrocephalus ◽

Case Series ◽

Preoperative Embolization ◽

Initial Symptom ◽

Lower Cranial Nerve ◽

The Mean

Abstract Background Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. Material and Method We share the surgical difficulties and outcome in this case series of large solid hemangioblastomas without preoperative embolization as an adjunct. This study included five patients (three men and two women, with a mean age of 42.2 years). Preoperative embolization was attempted in one patient but was unsuccessful. All the patients have headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt was inserted in one case before definite surgery due to obstructive hydrocephalus. The surgical outcome was measured using the Karnofsky Performance Status (KPS) score. Result The tumor was excised completely in all the cases. No intra- and postoperative morbidity occurred in four patients; one patient developed transient lower cranial nerve palsy. Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up was 80.One patient had a KPS score of 60. Conclusion Our treatment strategy is of circumferential dissection followed by en bloc excision, which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts as color duplex sonography and indocyanine green video angiography may help complete tumor excision with a lesser risk of complication. Preoperative embolization may not be needed to resect large solid posterior fossa hemangioblastoma, including those at the cerebellopontine angle location.

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Cisternography and CT Scanning with 111In-DTPA in Evaluation of Posterior Fossa Arachnoid Cysts

Clinical Nuclear Medicine ◽

10.1097/00003072-197904000-00006 ◽

1979 ◽

Vol 4 (4) ◽

pp. 161-163 ◽

Cited By ~ 5

Author(s):

JOHN LUSINS ◽

HIROSHI NAKAGAWA ◽

MOSHE SOREK ◽

STANLEY GOLDSMITH

Keyword(s):

Posterior Fossa ◽

Ct Scanning ◽

Arachnoid Cysts

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A surgical strategy to prevent delayed epidural hematoma after posterior fossa surgery using lateral suboccipital retrosigmoid approach

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2018.03.013 ◽

2018 ◽

Vol 52 ◽

pp. 156-158 ◽

Cited By ~ 2

Author(s):

Seunghoon Lee ◽

Sang-Ku Park ◽

Byung-Euk Joo ◽

Jeong-A Lee ◽

Doo-Sik Kong ◽

...

Keyword(s):

Posterior Fossa ◽

Epidural Hematoma ◽

Surgical Strategy ◽

Retrosigmoid Approach ◽

Posterior Fossa Surgery

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Endoscopic cystoventriculostomy for treatment of paraxial arachnoid cysts

Journal of Neurosurgery ◽

10.3171/2008.7.jns0841 ◽

2009 ◽

Vol 110 (4) ◽

pp. 792-799 ◽

Cited By ~ 29

Author(s):

Joachim M. K. Oertel ◽

Jörg Baldauf ◽

Henry W. S. Schroeder ◽

Michael R. Gaab

Keyword(s):

Fourth Ventricle ◽

Case Series ◽

Arachnoid Cysts ◽

Surgical Time ◽

Cyst Size ◽

Residual Symptoms ◽

Surgical Case ◽

Initial Procedure ◽

The Mean

Object The optimal therapy of arachnoid cysts is controversial. In symptomatic extraventricular arachnoid cysts, fenestration into the basal cisterns is the gold standard. If this is not feasible, shunt placement is frequently performed although another endoscopic option is available. Methods Between March 1997 and June 2006, 12 endoscopic cystoventriculostomies were performed for the treatment of arachnoid cysts in 11 patients (4 male and 7 female patients, mean age 52 years [range 14–71 years]). All patients were prospectively followed up. Results In 11 cases, the arachnoid cysts were frontotemporoparietal and fenestration was performed into the lateral ventricle. In 1 case, the arachnoid cyst was located in the cerebellum and the cyst was fenestrated into the fourth ventricle. Neuronavigational guidance was used in all but 1 case. Endoscopic cystoventriculostomy was performed in all cases without complications. No stents were placed. The mean surgical time was 71 minutes (range 30–110 minutes). The mean follow-up period was 42.7 months (range 19–96 months) per surgical case and 48.8 months (range 19–127 months) per patient. Symptoms improved after 11 of the 12 procedures; 7 of the 11 patients became symptom-free and the others had only mild residual symptoms. The patient who did not experience clinical improvement suffered from depression and demonstrated a significant decrease of the cyst size on the postoperative MR imaging. After 11 of 12 procedures, a decrease in cyst size was observed. In 1 case, a subdural hematoma developed; it required surgical treatment 3 months after surgery. In another case, reclosure of the stoma required repeated endoscopic cystoventriculostomy more than 7 years after the initial procedure. Conclusions Overall, endoscopic cystoventriculostomy represents a useful treatment option for patients with paraxial arachnoid cysts in whom a standard cystocisternotomy is not feasible. Based on the results in this case series, stent placement appears not to be required. Despite the long mean follow-up of almost 4 years, however, a longer follow-up period seems to be required before definite conclusions can be drawn.

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