Medical Student The Ohio State University College of Medicine Columbus, Ohio, United States
Introduction: Intracranial arachnoid cysts (ACs) are collections of cerebrospinal fluid that are enveloped by arachnoid membrane and they comprise 1% of all non-traumatic intracranial masses. Surgery is indicated for patients who are symptomatic, but there is debate as to which surgical approach is superior. A wide range of treatment options can be utilized for the management of ACs including shunting, excision or marsupialization of the cyst, microsurgical fenestration, and endoscopic fenestration to form a passageway between the cavity of the cyst and the subarachnoid space.
Methods: A retrospective chart review was conducted of two patients with similar interpeduncular fossa ACs and their surgical management and outcomes were described.
Results: The authors report a series of 2 patients with giant interpeduncular fossa ACs who were surgically managed via endoscopic transcortical transventricular fenestration of their cyst. In both cases, intraoperative findings included an absent floor of third ventricle and fenestration was performed under direct visualization. A 36-year-old female presented with debilitating daily headaches and reported that the frequency of her headaches had reduced to 1-2 per week 5 months postoperatively (Figure 1). A 33-year-old male who was evaluated by a neuro ophthalmologist and found to have worsening bitemporal hemianopsia as well as headaches and mild memory loss experienced significant improvement in his bitemporal hemianopsia as well as complete resolution of headaches 1 year postoperatively (Figure 2). In both cases, follow up MRIs demonstrated mild decrease in cyst size and significant improvement in symptoms.
Conclusion : This endoscopic fenestration technique allows for a minimally invasive intervention to achieve AC decompression by establishing a connection between the cyst cavity and normal cerebrospinal fluid pathways. It is a safe technique that yields good results and low complication rates. Further studies are necessary to better characterize the optimal treatment strategy in patients with intracranial ACs.
