Endoscopic Management of Intracranial Cysts
Endoscopic Management of Intracranial Cysts
Object: Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used. This review was conducted to assess what variables influence the treatment success for different categories of arachnoid cysts.
Methods: Thirty-three consecutive patients who underwent endoscopic fenestration for treatment of an intracranial arachnoid cyst were identified from a prospective database. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Specific examples of each cyst category are included to illustrate the technical aspects of endoscopic cyst fenestration.
Endoscopic fenestration of arachnoid cysts was successful when judged by cyst decompression, and symptom resolution was noted in 32 (97%) of 33 cases. The one patient with short-term treatment failure underwent a successful repetition of the operation. There were no surgery-related morbidities or deaths.
Conclusions: Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluidcontaining cisterns. Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensity combine to make this a safe procedure with excellent outcomes.
Endoscopic management of intracranial pathological conditions has always posed a unique challenge. Nevertheless, the diversity of pathological entities that are accessible via endoscopy is equaled only by the number of creative approaches neurosurgeons have devised to treat them. The anatomy of the ventricular system lends itself to direct approaches for certain intraventricular lesions, or it can be used as a conduit through which less accessible lesions can be reached. In this report we will review several cystic intracranial pathological entities and discuss those lesions and regions most amenable to endoscopic management, with a focus on the surgical management of arachnoid cysts. Although there is a wide diversity of anatomical locations within which arachnoid cysts are found, we will highlight three common ones: the middle fossa, the septal region, and the suprasellar or prepontine cisterns. We will review the anatomy of and approaches to each region as well as our own experience in the endoscopic management of these challenging lesions.
Endoscopy has been used successfully for decades to treat a variety of pathologies within the central nervous system, including removal of colloid cysts, biopsy sampling and removal of intraventricular brain tumors, treatment of obstructive hydrocephalus, and management of intracranial cysts. Using the conduits of the ventricular system for endoscopic access to lesions such as colloid cysts or intraventricular tumors is intuitive. Other cystic lesions, including arachnoid, septum pellucidum, porencephalic, and pineal cysts, and cysts from multiloculated hydrocephalus, are equally favorable to treat endoscopically, because of their position adjacent to subarachnoid or intraventricular spaces. In this review, however, we will focus exclusively on arachnoid cysts and their management with endoscopic technology.
Object: Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used. This review was conducted to assess what variables influence the treatment success for different categories of arachnoid cysts.
Methods: Thirty-three consecutive patients who underwent endoscopic fenestration for treatment of an intracranial arachnoid cyst were identified from a prospective database. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Specific examples of each cyst category are included to illustrate the technical aspects of endoscopic cyst fenestration.
Endoscopic fenestration of arachnoid cysts was successful when judged by cyst decompression, and symptom resolution was noted in 32 (97%) of 33 cases. The one patient with short-term treatment failure underwent a successful repetition of the operation. There were no surgery-related morbidities or deaths.
Conclusions: Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluidcontaining cisterns. Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensity combine to make this a safe procedure with excellent outcomes.
Endoscopic management of intracranial pathological conditions has always posed a unique challenge. Nevertheless, the diversity of pathological entities that are accessible via endoscopy is equaled only by the number of creative approaches neurosurgeons have devised to treat them. The anatomy of the ventricular system lends itself to direct approaches for certain intraventricular lesions, or it can be used as a conduit through which less accessible lesions can be reached. In this report we will review several cystic intracranial pathological entities and discuss those lesions and regions most amenable to endoscopic management, with a focus on the surgical management of arachnoid cysts. Although there is a wide diversity of anatomical locations within which arachnoid cysts are found, we will highlight three common ones: the middle fossa, the septal region, and the suprasellar or prepontine cisterns. We will review the anatomy of and approaches to each region as well as our own experience in the endoscopic management of these challenging lesions.
Endoscopy has been used successfully for decades to treat a variety of pathologies within the central nervous system, including removal of colloid cysts, biopsy sampling and removal of intraventricular brain tumors, treatment of obstructive hydrocephalus, and management of intracranial cysts. Using the conduits of the ventricular system for endoscopic access to lesions such as colloid cysts or intraventricular tumors is intuitive. Other cystic lesions, including arachnoid, septum pellucidum, porencephalic, and pineal cysts, and cysts from multiloculated hydrocephalus, are equally favorable to treat endoscopically, because of their position adjacent to subarachnoid or intraventricular spaces. In this review, however, we will focus exclusively on arachnoid cysts and their management with endoscopic technology.
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