Transventricular transforaminal endoscopic fenestration with cysto-ventriculoperitoneal shunt to manage a third ventricular arachnoid cyst: a case report
Regular ventriculoperitoneal (VP) shunt is commonly used as the first option to manage a third ventricular arachnoid cyst due to the lack of facilities, unfamiliarity with endoscopic techniques, or misdiagnosis as purely obstructive hydrocephalus. A 9-year-old girl with obstructive hydrocephalus due to a third ventricular arachnoid cyst was treated with a VP shunt. 2 months later, the previous shunt device was removed due to an infection. Following a sterile cerebrospinal fluid analysis culture, we conducted a navigation-assisted transventricular transforaminal endoscopic fenestration and cysto-VP programmable shunt placement. A decrease in ventricular dilatation was seen on follow-up. This approach was justified due to the possibility of establishing communication with normal cisterns, the high rate of cyst elimination, and the potential for achieving shunt independence. Performing an endoscopic fenestration followed by cysto-VP shunt placement could be an optimal option for managing this condition.
Helland CA, Wester K. A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry. 2007;78(10):1129-35. https://doi.org/10.1136/jnnp.2006.107995
Copley P, Kirkman MA, Thompson D, James G, Aquilina K. Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period. Child's Nerv Syst. 2018;34(2):257-66. https://doi.org/10.1007/s00381-017-3524-9
Kelly KA, Sherburn MM, Sellyn GE, Ahluwalia R, Foster J, Shannon CN, et al. Management of suprasellar srachnoid cysts in children: a systematic literature review highlighting modern endoscopic approaches. World Neurosurg. 2020;141:e316-23. https://doi.org/10.1016/j.wneu.2020.05.122
Sprau AC, McCrea HJ. Intracranial arachnoid cysts in an infant: a technical note on the innovative use of navigation and flexible endoscopy for cyst fenestration. Surg Neurol Int. 2021;12:160. https://doi.org/10.25259/SNI_81_2021
El-Ghandour NMF. Endoscopic treatment of intracranial cysts in infants: personal experience and review of literature. Child's Nerv Syst. 2021;37(11):3447-53. https://doi.org/10.1007/s00381-021-05264-y
Erşahin Y, Kesikçi H, Rüksen M, Aydin C, Mutluer S. Endoscopic treatment of suprasellar arachnoid cysts. Child's Nerv Syst. 2008;24(9):1013-20. https://doi.org/10.1007/s00381-008-0615-7
Gangemi M, Colella G, Magro F, Maiuri F. Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg. 2007;21(3):276-80. https://doi.org/10.1080/02688690701339197
Mustansir F, Bashir S, Darbar A. Management of arachnoid cysts: a comprehensive review. Cureus. 2018;10(4):e2458. https://doi.org/10.7759/cureus.2458
Kirollos RW, Javadpour M, May P, Mallucci C. Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Child's Nerv Syst. 2001;17(12):713-8. https://doi.org/10.1007/s003810100494
Ma GF, Li CZ, Zhang YZ, Wang XS, Zhao P, Gui SB. A good choice for the patients with prior failed ventriculoperitoneal shunt treatment of suprasellar arachnoid cysts: endoscopic fenestration. Neurosurg Rev. 2020;43(5):1373-81. https://doi.org/10.1007/s10143-019-01152-x
Hayes MJ, TerMaath SC, Crook TR, Killeffer JA. A review on the effectiveness of surgical intervention for symptomatic intracranial arachnoid cysts in adults. World Neurosurg. 2019;123:e259-72. https://doi.org/10.1016/j.wneu.2018.11.149
Özek MM, Urgun K. Neuroendoscopic management of suprasellar arachnoid cysts. World Neurosurg. 2013;79(2 suppl):S19.e13-8. https://doi.org/10.1016/j.wneu.2012.02.011
Alexiou GA, Varela M, Sfakianos G, Prodromou N. Shunting for the treatment of arachnoid cysts in children. Neurosurgery. 2010;67(6):1632-6. https://doi.org/10.1227/NEU.0b013e3181f94476
Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C. Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst. 2003;19(3):159-65. https://doi.org/10.1007/s00381-003-0724-2
Akpinar E, Gürbüz MS, Okutan MÖ, Beşkonakli E. Third ventricle arachnoid cyst presenting with acute hydrocephalus: a case report and review of the literature. Medeni Med J. 2018;33(3):247-51. https://doi.org/10.5222/MMJ.2018.67878
Pitsika M, Sgouros S. Volume change of cranial arachnoid cysts after successful endoscopic fenestration in symptomatic children. Childs Nerv Syst. 2019;35(12):2313-8. https://doi.org/10.1007/s00381-019-04315-9
El Refaee E, Elbaroody M. Endoscopic fenestration of arachnoid cysts through lateral pontomesencephalic membranotomy: technical note and case series. World Neurosurg. 2021;148:54-64. https://doi.org/10.1016/j.wneu.2020.12.108
Mottolese C, Szathmari A, Simon E, Ginguene C, Ricci-Franchi AC, Hermier M. The parallel use of endoscopic fenestration and a cystoperitoneal shunt with programmable valve to treat arachnoid cysts: experience and hypothesis. J Neurosurg Pediatr. 2010;5(4):408-14. https://doi.org/10.3171/2009.11.PEDS08435
Cinalli G, Spennato P, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, et al. Complications following endoscopic intracranial procedures in children. Childs Nerv Syst. 2007;23(6):633-44. https://doi.org/10.1007/s00381-007-0333-6
Oi S. Classification and definition of hydrocephalus: origin, controversy, and assignment of the terminology. In: Cinalli G, Sainte-Rose C, Maixner WJ, editors. Pediatric Hydrocephalus. Springer; 2005. p. 95-111. https://doi.org/10.1007/978-88-470-2121-1_6
Choi JU, Kim DS, Huh R. Endoscopic approach to arachnoid cyst. Childs Nerv Syst. 1999;15(6-7):285-91. https://doi.org/10.1007/s003810050396
Copyright (c) 2023 Nia Yuliatri, Ingrid Ayke Widjaya, Alphadenti Harlyjoy, Gibran Aditiara Wibawa, Satyanegara
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.