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Pediatric interhemispheric arachnoid cyst: An institutional experience
Dipanker Singh Mankotia1, Hardik Sardana1, Sumit Sinha1
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Interhemispheric arachnoid cysts (IHACs) in children can be effectively managed with either endoscopic fenestration or shunt surgery. Both surgical approaches demonstrated safety and efficacy in a small pediatric cohort.
Area of Science:
- Pediatric Neurosurgery
- Congenital Neurological Disorders
- Cystic Lesions of the Brain
Background:
- Interhemispheric arachnoid cysts (IHACs) are rare congenital brain malformations, representing less than 5% of all arachnoid cysts.
- Optimal surgical management for symptomatic IHACs remains debated due to a lack of established guidelines.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical interventions for pediatric interhemispheric arachnoid cysts.
- To compare outcomes of endoscopic cyst fenestration versus cystoperitoneal shunt surgery in IHAC management.
Main Methods:
- Retrospective analysis of six pediatric patients with IHACs treated between 2012 and 2015.
- Surgical procedures included endoscopic cystoventriculostomy, cystocisternostomy, and cystoperitoneal shunt (three patients each).
- All patients were male, with a median age of 13 months at presentation.
Main Results:
- Common presentations included macrocrania, seizures, infantile spasms, and developmental delay.
- Mean follow-up duration was 24.16 months (range: 3-36 months).
- All patients showed cyst size reduction and head size stabilization, with no need for reoperation.
Conclusions:
- Endoscopic cyst fenestration and shunt surgery are both safe and effective treatment options for pediatric IHACs.
- These surgical strategies lead to favorable outcomes, including cyst reduction and clinical stabilization.
Background:
Interhemispheric arachnoid cysts (IHACs) are a rare type of congenital arachnoid cyst accounting for <5% of all cases. The optimum surgical management of symptomatic IHAC is still controversial, and there are no clear guidelines.
Materials And Methods:
Retrospective analysis of six pediatric patients of IHAC operated from 2012 to 2015 at our institute. There was definitive sex predisposition with all patients being males. Endoscopic cystoventriculostomy, cystocisternostomy, and cystoperitoneal shunt surgeries were performed in three patients each.
Results:
The median age at presentation was 13 months. The most common clinical presentations were macrocrania with rapidly increasing head size, seizures, infantile spasms, and developmental delay. The mean duration of follow-up was 24.16 months (range: 3-36 months). Cyst size decreased in all the patients on follow-up imaging. Head size stabilized in all the patients. None of the patients required a second surgical procedure till the last follow-up.
Conclusions:
Both endoscopic cyst fenestration and shunt surgery are safe and effective in management of IHAC.
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