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![CT scan axial images of a case of multiloculated hydrocephalus. A Preoperative, showing multiple cysts inside the ventricular system. B Postoperative, performed 3 months after endoscopic fenestration, showing improvement of hydrocephalus, opening of subarachnoid space, increase in cerebral mantle and restoration of ventricular architecture (reprinted from J Neurosurg Pediatr, El-Ghandour 2008) [3]](publication/353012135/figure/fig2/AS:1042437887782914@1625547968655/CT-scan-axial-images-of-a-case-of-multiloculated-hydrocephalus-A-Preoperative-showing.jpg)
CT scan axial images of a case of multiloculated hydrocephalus. A Preoperative, showing multiple cysts inside the ventricular system. B Postoperative, performed 3 months after endoscopic fenestration, showing improvement of hydrocephalus, opening of subarachnoid space, increase in cerebral mantle and restoration of ventricular architecture (reprinted from J Neurosurg Pediatr, El-Ghandour 2008) [3]
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Background
A wide variety of intracranial cysts is known to occur in infants. If symptomatic, they require treatment; the ideal surgical treatment and indications of surgery are yet a matter of discussion. Traditional treatment is either by cystoperitoneal shunting, or microsurgical fenestration. Endoscopic treatment is an alternative procedure tha...
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A BSTRACT
Background
Arachnoid cysts (ACs) are non-neoplastic collections of cerebrospinal fluid, often posing challenges in diagnosis and management due to their rarity and varied clinical presentations. This systematic review aims to investigate the frequency of ACs, analyse optimal intervention approaches and evaluate neurological complications...
Introduction: Among intracranial space-occupying lesions, arachnoid cysts compromise 1% only. Abnormal collection of cerebrospinal fluid occurs in these types of cysts leading to pressure symptoms. Developmental abnormalities of cerebrospinal structures in early fetal life lead to the primary type of arachnoid cysts, while the second type of arachn...
A 6-month-old, previously healthy boy presented with poor feeding and vomiting for 2 weeks. At presentation, his left supraorbital vein was found to engorge considerably. A cranial computed tomography (CT) scan revealed a large cyst in the posterior fossa with a prominent left superior ophthalmic vein (SOV). Magnetic resonance imaging delineated th...
Background
Arachnoid cysts (AC) may cause hydrocephalus and neurological symptoms, necessitating surgical intervention. Cyst drainage may result in postoperative complications, however, these interventions are not normally associated with the subsequent development of acute hydrocephalus. Herein, we present two unique cases of AC drainage with post...
BACKGROUND
Arachnoid cysts are often congenital, asymptomatic lesions detected in the pediatric population. When seen in adults, they usually occur following trauma. De novo formation of arachnoid cysts is uncommon, with only a few instances cited in the literature and most of which occurred in the pediatric population. Treatment options for these...
Citations
... Microsurgical cyst fenestration with open craniotomy for cyst resection can avoid the risk of permanent shunt malfunction. 5,13 Moreover, rapid cyst decompression may cause insufficient CSF absorption and subdural hygromas owing to wide surgical apertures. 14,15 Therefore, the inherent risks of open craniotomy should be considered in patients with minor symptoms related to arachnoid cysts. ...
... 3 In the present study, the patient was treated with VCC rather than VC because VCC was associated with a lower incidence of recurrence, risk of infection, and other postoperative problems. 2,5 Although usually successful, VCC may present additional risks to nearby anatomical structures, such as the basilar artery and cranial nerves. 3 Surgery aims to reduce the size of the cyst and the associated hydrocephalus to normalize CSF flow. ...
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.
... Typically, growing or symptomatic RCCs are treated via a trans-sphenoidal approach [2]. Similar to other sellar lesions and also other intracranial cystic lesions in adults and pediatric patients, the endoscopic techniques have become the preferable option by most institutions in the last decades [7,8]. ...
Background:
Rathke's cleft cysts (RCC) arise from the pars intermedia because of incomplete regression of the embryologic Rathke pouch. A subset of RCC becomes symptomatic causing headaches, visual and endocrinological disturbances such that surgical intervention is indicated. Several points in surgical management remain controversial including operative strategy (simple fenestration (SF) vs complete cyst wall resection (CWR)) as well as reconstructive techniques.
Methods:
A retrospective analysis was conducted of pathologically confirmed RCC operated on by endoscopic endonasal approach from 2006 to 2019. Pre-operative symptoms, imaging characteristics, operative strategy, symptom response, complications and recurrences were recorded.
Results:
Thirty-nine patients were identified. Thirty-three underwent SF and six underwent CWR. Worsening pituitary function was significantly increased with CWR (50%) compared to SF (3%) (p = 0.008). All patients underwent "closed" reconstruction with a post-operative CSF leak rate of 5% (3% SF vs 16% CWR, p = 0.287). Six (15%) recurrences necessitating surgery were reported. Recurrence rates stratified by surgical technique (18% SF vs 0% CWR, p = 0.564) were not found to be significantly different.
Conclusions:
The current series illustrates variability in the surgical management of RCCs. SF with closed reconstruction is a reasonable operative strategy for most symptomatic RCCs cases while CWR can be reserved for selected cases.
