Neuroendoscopic management of middle fossa arachnoid cysts

The purpose of this study is to analyze symptomatic middle fossa arachnoid cysts and describe the advantages of the endoscopic technique to manage those cases that should be resolved surgically.

The physiopathology is described, and the clinical manifestations are analyzed. The diagnostic methodology and the surgical indications are presented. The endoscopic surgical technique is described thoroughly, and the advantages of the method are stated based on a series of 28 operated cases. The endoscope of choice has been a rigid endoscope with a 0° lens.

All the cases in our series were solved by means of the endoscopic technique. One patient developed meningitis, recovering with antibiotic treatment, and 3 patients developed subdural hygromas: 2 were treated by means of subdural-peritoneal shunting, and the remaining subdural hematoma required surgical drainage. All of the complications reported occurred in patients affected by cysts classified as Galassi type III. There was no mortality.

The effectiveness of neuroendoscopic management of middle fossa arachnoid cysts has not yet been superseded by any other surgical treatment. It has been shown to be a simple, reliable, and fast procedure, with a low rate of complications and shorter hospital stay. In general, patients can resume their usual daily activities quite soon.