Neuroendoscopic fenestration of arachnoid cysts

The authors report 6 patients with arachnoid cysts treated endoscopically. The series includes 6 patients with temporobasal arachnoid cysts. The age of the patients at the time of diagnosis ranged from 5 to 71 years. The patients' symptoms included headache, seizures, vomiting, nausea, dizziness, and problems with balance. The authors performed cystocisternostomies via burr holes with the aid of a universal neuroendoscopic system. In 4 cases the endoscopic fenestration was a unique treatment which enabled the avoidance of a definitive cystoperitoneal shunt. In the two cases treated subsequently, cystoperitoneal shunts were performed. The surgical endoscopic technique and the postoperative radiological findings which indirectly confirm the patency of the fenestration are discussed. The authors conclude that endoscopic fenestration of intracranial fluid cysts represents the treatment of preference. In cases where the endoscopic procedure fails a microneurosurgical procedure or cystoperitoneal shunting is recommended to avoid exposing the patient to additional risk.