Endoscopic management of cranial arachnoid cysts using extra-channel method

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Endoscopic Techniques

Background:

• Arachnoid cysts (ACs) are benign fluid-filled sacs that can cause neurological symptoms due to mass effect.
• Traditional endoscopic fenestration through the working channel (intra-channel) may be limited in achieving adequate cyst-brain communication.
• Surgical intervention is often necessary for symptomatic ACs to relieve pressure on adjacent brain structures.

Purpose of the Study:

• To introduce and evaluate a novel extra-channel endoscopic technique for arachnoid cyst fenestration.
• To demonstrate the feasibility and efficacy of this technique in a series of patients with symptomatic arachnoid cysts.
• To compare the outcomes of the extra-channel method with conventional intra-channel endoscopic procedures.

Main Methods:

• Nine patients with symptomatic cortical arachnoid cysts underwent fenestration using an extra-channel endoscopic technique via a single burr hole.
• The extra-channel method involves fenestration through the space between the endoscope shaft and guiding cannula, creating a dry operating field.
• Procedures were performed on patients aged 3 to 60 years, with follow-up ranging from 12 to 26 months.

Main Results:

• The extra-channel endoscopic technique achieved successful treatment in 88.9% (8/9) of patients.
• Among successfully treated patients, 66.7% (6/8) showed cyst reduction, and 22.2% (2/8) experienced complete cyst disappearance.
• One patient required a shunt procedure, while the remaining eight showed significant clinical improvement.

Conclusions:

• The extra-channel endoscopic method is a simple, effective, and valuable technique for arachnoid cyst fenestration.
• This approach offers a wider working area and potentially better outcomes compared to conventional intra-channel endoscopic procedures.
• The technique holds promise for improved management of symptomatic arachnoid cysts.