The role of endoscopic fenestration procedures for cerebral arachnoid cysts

Recently, endoscopic procedures have been recommended as the first surgical option for cerebral arachnoid cyst (AC). The author reports seven ACs treated endoscopically and discuss the role of endoscopic fenestration. The age of the patients ranged from two to 62 years. Three ACs were located in the posterior cranial fossa, two in the suprasellar area, one in the middle cranial fossa, and one in the convexity. All cases were examined by cine magnetic resonance (MR) flow study. The patient's symptoms included headache, vomiting, dizziness, problems in balance, visual disturbance, and seizure. The author performed a cysto-cisternostomy or cysto-ventriculostomy via a single burr hole. The follow-up periods ranged from six to 18 months. There was no mortality or morbidity except one case of intracisternal bleeding during endoscopic procedure. Symptoms were relieved in all seven patients. Follow-up imaging studies revealed a decrease in the size or disappearance of the cysts. The results support that the minimal fenestration procedure as possibly as preserving the internal environment is valuable for the management of ACs.