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Updated: Sep 28, 2026
Endoscopic Approach for Colloid Cyst Resection
Published on: May 23, 2025
[Treatment of intracranial cysts in children: peritoneal derivation or endoscopic fenestration?]
A Pierre-Kahn1, A Carpentier, D Parisot
1Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Université Paris V - René-Descartes, 149, rue de Sèvres, 75743 Paris Cedex 15, France. alain.kahn2nck.ap-hop-paris.fr
Insights
Endoscopic fenestrations are more successful and safer than shunts for treating malformative intracranial cysts. This minimally invasive approach is preferred when feasible, offering better outcomes for pediatric patients.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Cranial Surgery
Context:
- Malformative intracranial cysts present unique surgical challenges in pediatric populations.
- Treatment decisions for these cysts involve balancing efficacy, complication rates, and patient outcomes.
- Previous studies have explored various interventions, but direct comparisons of endoscopic fenestration and shunting are crucial.
Purpose:
- To evaluate the indications, benefits, and complications of shunts versus endoscopic fenestrations in treating malformative intracranial cysts.
- To compare the success rates, complication profiles, and reoperation needs of these two primary surgical interventions.
- To assess the long-term neurodevelopmental outcomes in children treated for these cysts.
Summary:
- A retrospective review of 172 pediatric patients with malformative intracranial cysts (excluding specific types) was conducted.
- Endoscopic fenestration demonstrated higher success rates (70%) and significantly fewer complications (6%) and reoperations compared to shunting (61.8% success, 61.8% complications).
- Developmental and intellectual quotients were comparable across treatment groups, suggesting that while treatment type impacts complications, overall neurodevelopment may be less affected.
Impact:
- Endoscopic fenestration is a preferable treatment for malformative intracranial cysts when anatomically feasible, offering improved safety and efficacy.
- This study provides evidence to guide surgical decision-making, potentially reducing patient morbidity associated with shunting procedures.
- Findings support the adoption of minimally invasive techniques in pediatric neurosurgery for better patient outcomes.
Objective:
The goal of this study is to evaluate the indications, benefit and complications of shunts and endoscopic fenestrations in the treatment of malformative intracranial cysts.
Material And Method:
The records of 172 consecutive children (mean age of 4 years) were reviewed. All had a malformative cyst. Dandy Walker malformation, mega cisterna magna, and cysts from tumoral or porencephalic origin were excluded from the study. The cysts were diagnosed either in utero (n=64) or postnatally (n=108). Most of them were unique (94.8%) and localized in the posterior fossa (26.2%) or at the convexity (23.2%). Indication for surgery was based on clinical symptoms (n=101; 86.3%) or size of the lesion (n=16; 13.7%). Endoscopy was the treatment of choice when cysts were in closed relationship with enlarged ventricles. Shunting procedures were indicated when endoscopy was not feasible and craniotomies when shunt insertion was unsafe or diagnosis uncertain. Fifty children underwent an endoscopic fenestration, 55 a shunting procedure, 7 the puncture or the external drainage of a pericerebral collection and 5 a direct surgical approach. The mean follow-up was 5.5 years. Psycho-motor, intellectual and school performances were evaluated in 93 children (54%). Success was defined by both the disappearance of symptoms of increased intra cranial pressure and regression of the cyst.
Results:
Compared to shunts, endoscopic fenestrations were more frequently successful (70% vs 61.8%), led to less complications (6% vs 61.8%) and to a lesser number of reoperations (in average 1.6 operation per child vs 2.2). Median developmental and intellectual quotients for the whole series were respectively 98 and 97 and did not depend upon the type of treatment.
Conclusion:
The study of this series shows that treatment modalities necessarily vary according to the site of the cysts but that endoscopic fenestrations are preferable to shunts whenever feasible.
