NEUROENDOSCOPIC APPROACH TO ARACHNOID CYSTS

A prospective study of seven consecutive patients with congenital arac hnoid cysts treated endoscopically is reported. The ages of the patien ts at the time of diagnosis ranged from 5 to 47 years with three patie nts under 15 years. Two cysts were located in the posterior cranial fo ssa, four in the middle cranial fossa, and one in the suprasellar-prep ontine area. The patients' symptoms included headache, seizures, vomit ing, nausea, dizziness, balance problems, and precocious puberty. The authors performed cystocisternostomies and ventriculocystostomies via burr holes with the aid of a universal neuroendoscopic system. Minor b leeding was easily controlled by rinsing. In one case, the endoscopic procedure had to be abandoned because of significant bleeding, which o bscured a clear operative view, and an open microsurgical cyst fenestr ation was performed. The follow-up review periods in this group of pat ients ranged from 15 to 30 months. There was no mortality or morbidity . Symptoms were relieved in five patients and improved in one. Pre coc ious puberty in one case continued. In six cases, follow-up magnetic r esonance images or computerized tomography scans revealed a decrease i n the size of the cysts. Although the follow-up period is too shea to make statements on long-term outcome, the authors recommend the minima lly invasive endoscopic approach for treatment of arachnoid cysts as t he first therapy of choice. Should the endoscopic procedure fail, esta blished treatment options such as microsurgical fenestration or cystop eritoneal shunting can subsequently be performed without causing addit ional risk to the patient.