Stereotactic cysto-ventricular shunting in diencephalic (arachnoid) cysts

Stereotactic cysto-ventricular shunting in three patients with congenital (subependymal cyst of the 3rd ventricle, subependymal cyst of foramen of Monroi, cyst of cavum septi pellucidi) is dealt with in this paper. The first operation was performed in May 1992 and the latest, being considered in this paper, in January 1993. All patients were admitted to our hospital suffering from increased intracranial pressure. CT-scans revealed an obstructive hydrocephalus subjected to the cystic lesions. After stereotactic puncture of these cysts, aspiration of their contents as well as biopsy of the wall a silicone catheter was implanted, thus constructing a permanent communication between the cyst and the lateral or 3rd ventricle. The internal catheter was connected to a subcutaneous burr-hole reservoir. All patients recovered uneventfully without neurological deficits. There were no operative complications. Follow-up CT-scans showed no recurrences of the cysts and obstructive hydrocephalus. Resulting from our experiences, it is quite obvious that the stereotactic internal shunt implantation seems to be a safe, proper and reliable method in the treatment of such cystic lesions. Open craniotomy or intracorporal shunting procedures and their immanent complications can be avoided for most cases of congenital intracranial cysts. It should, therefore, be the aim of further clinical investigations to prove the value of this method in additional cases.