Acta Neurochirurgica

, Volume 158, Issue 4, pp 655–662 | Cite as

Transaqueductal trans-Magendie fenestration of arachnoid cyst in the posterior fossa

  • Alberto FelettiEmail author
  • Matteo Alicandri-Ciufelli
  • Giacomo Pavesi
Technical Note - Neurosurgical Techniques



Neuroendoscopy is currently recommended as the first choice to treat posterior fossa arachnoid cysts. It has proven to be effective, providing improved outcome, and safe, having a low complication rate. Compared to craniotomy and shunt placement, it has lower surgical morbidity, minimizing or avoiding risks of subdural fluid collections, shunt infection, malfunction, overdrainage, and dependence. Usually, rigid scopes maneuvered through a suboccipital approach are used. When symptomatic obstructive hydrocephalus develops, CSF diversion is the first aim of surgery.


In these patients, a flexible scope introduced through a frontal burr hole allows not only immediate and efficient management of hydrocephalus with endoscopic third-ventriculostomy, but in selected cases also direct cyst inspection and fenestration. Navigation of an enlarged cerebral aqueduct is actually safe when performed by experienced neurosurgeons.


We describe the cystocisternostomy of a cisterna magna arachnoid cyst using a transaqueductal trans-Magendie approach.


This minimally invasive technique gives the possibility of performing both endoscopic third-ventriculostomy and cyst fenestration, which alone may not be enough to efficiently treat hydrocephalus.


Arachnoid cyst Posterior fossa Neuroendoscopy Hydrocephalus Cyst fenestration Transaqueductal 


Compliance with ethical standards


The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Patient consent

The patient has consented to the submission of this technical note to the journal.


  1. 1.
    Buxton N, Vloeberghs M, Punt J (1999) Flexible neuroendoscopic treatment of suprasellar arachnoid cysts. Br J Neurosurg 13:316–318CrossRefPubMedGoogle Scholar
  2. 2.
    Caemaert J, Abdullah J, Calliauw L, Carton D, Dhooge C, van Coster R (1992) Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 119:68–73CrossRefGoogle Scholar
  3. 3.
    Choi JU, Kim DS, Huh R (1999) Endoscopic approach to arachnoid cyst. Childs Nerv Syst 15:285–291CrossRefPubMedGoogle Scholar
  4. 4.
    Choong CT, Lee SH (1998) Subdural hygroma in association with middle fossa arachnoid cysts: acetazolamide therapy. Brain Dev 20:319–322CrossRefPubMedGoogle Scholar
  5. 5.
    Cianciulli E (2010) Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases. J Neurosurg Pediatr 6:489–497CrossRefPubMedGoogle Scholar
  6. 6.
    Cinalli G, Peretta P, Spennato P, Savarese L, Varone A, Vedova P, Grimaldi G, Ragazzi P, Ruggiero C, Cianciulli E, Maggi G (2006) Neuroendoscopic management of interhemispheric cysts in children. J Neurosurg 105(3 Suppl):194–202PubMedGoogle Scholar
  7. 7.
    Cinalli G, Spennato P, Columbano L, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, Cianciulli E (2010) Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases. J Neurosurg Pediatr 6:489–497CrossRefPubMedGoogle Scholar
  8. 8.
    Dei-Anang K, Voth D (1989) Cerebral arachnoid cyst: a lesion of the child’s brain. Neurosurg Rev 12:59–62CrossRefPubMedGoogle Scholar
  9. 9.
    Di Rocco C, Caldarelli M, Ceddia A (1993) Incidence, anatomical distribution and classification of arachnoid cysts. In: Raimondi AJ, Choux M, Di Rocco C (eds) Intracranial cysts lesions. Springer-Verlag, New York, pp 103–111Google Scholar
  10. 10.
    Di Rocco C, Caldarelli M, Ceddia A (1993) Infratentorial arachnoid cysts. In: Raimondi AJ, Choux M, Di Rocco C (eds) Intracranial cyst lesions. Springer-Verlag, New York, pp 129–142CrossRefGoogle Scholar
  11. 11.
    El-Ghandour NMF (2011) Endoscopic treatment of suprasellar arachnoid cysts in children. Clin Article J Neurosurg Pediatr 8:6–14CrossRefGoogle Scholar
  12. 12.
    El-Ghandour NMF (2012) Endoscopic treatment of middle cranial fossa arachnoid cysts in children. Clin Article J Neurosurg Pediatr 9:231–238CrossRefGoogle Scholar
  13. 13.
    El-Ghandour NMF (2013) Endoscopic treatment of quadrigeminal arachnoid cysts in children. Clin Article J Neurosurg Pediatr 12:521–528CrossRefGoogle Scholar
  14. 14.
    El-Ghandour NMF (2014) Endoscopic treatment of intraparenchymal arachnoid cysts in children. J Neurosurg Pediatr 14:501–507CrossRefPubMedGoogle Scholar
  15. 15.
    Fernández Molina G (2013) Neuroendoscopic management of middle fossa arachnoid cysts. World Neurosurg 79(2 Suppl):S19.e19-23PubMedGoogle Scholar
  16. 16.
    Gangemi M, Maiuri F, Colella G, Sardo L (2001) Endoscopic surgery for large posterior fossa arachnoid cysts. Minim Invasive Neurosurg 44:21–24CrossRefPubMedGoogle Scholar
  17. 17.
    Gangemi M, Seneca V, Colella G, Cioffi V, Imperato A, Maiuri F (2011) Endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid cysts. J Neurosurg Pediatr 8:158–164CrossRefPubMedGoogle Scholar
  18. 18.
    Gazioglu N, Kafadar AM, Tanriover N, Abuzayed B, Bıceroglu H, Ciplak N (2010) Endoscopic management of posterior fossa arachnoid cyst in an adult: case report and technical note. Turk Neurosurg 20:512–518PubMedGoogle Scholar
  19. 19.
    Go KG, Houthoff HJ, Blaauw EH, Havinga P, Hartsuiker J (1984) Arachnoid cysts of the Sylvian fissure: evidence of fluid secretion. J Neurosurg 60:803–813CrossRefPubMedGoogle Scholar
  20. 20.
    Greenfield JP, Souweidane MM (2005) Endoscopic management of intracranial cysts. Neurosurg Focus 19:E7CrossRefPubMedGoogle Scholar
  21. 21.
    Hayashi Y, Kita D, Watanabe T, Yoshikawa A, Hamada J (2015) Symptomatic foramen of Magendie arachnoid cyst in an elderly patient. Surg Neurol Int 6:7CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Helland CA, Lund-Johansen M, Wester K (2010) Location, sidedness, and sex distribution of intracranial arachnoid cysts in a population-based sample. Clin Article J Neurosurg 113:934–939CrossRefGoogle Scholar
  23. 23.
    Hopf NJ, Perneczky A (1998) Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43:1330–1337PubMedGoogle Scholar
  24. 24.
    Huang Q, Wang D, Guo Y, Zhou X, Wang X, Li X (2007) The diagnosis and neuroendoscopic treatment of noncommunicating intracranial arachnoid cysts. Surg Neurol 68:149–154CrossRefPubMedGoogle Scholar
  25. 25.
    Karabatsou K, Hayhurst C, Buxton N, O’Brien DF, Mallucci CL (2007) Endoscopic management of arachnoid cysts: an advancing technique. J Neurosurg 106(6 Suppl):455–462PubMedGoogle Scholar
  26. 26.
    Kim MH (1999) The role of endoscopic fenestration procedures for cerebral arachnoid cysts. J Korean Med Sci 14:443–447CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    King JA, Auguste KI, Halliday W, Drake JM, Kulkarni AV (2010) Ventriculocystostomy and endoscopic third ventriculostomy/shunt placement in the management of hydrocephalus secondary to giant retrocerebellar cysts in infancy. J Neurosurg Pediatr 5:403–407CrossRefPubMedGoogle Scholar
  28. 28.
    Kirollos RW, Javadpour M, May P, Mallucci C (2001) Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718CrossRefPubMedGoogle Scholar
  29. 29.
    Longatti P, Basaldella L, Feletti A, Fiorindi A, Billeci D (2005) Endoscopic navigation of the fourth ventricle. Technical note and preliminary experience. Neurosurg Focus 19:E12CrossRefPubMedGoogle Scholar
  30. 30.
    Longatti P, Fiorindi A, Feletti A, Baratto V (2006) Endoscopic opening of the foramen of Magendie using transaqueductal navigation for membrane obstruction of the fourth ventricle outlets. Technical note. J Neurosurg 105:924–927CrossRefPubMedGoogle Scholar
  31. 31.
    Longatti P, Fiorindi A, Feletti A, d'Avella D, Martinuzzi A (2008) Endoscopic anatomy of the fourth ventricle. J Neurosurg 109:530–535CrossRefPubMedGoogle Scholar
  32. 32.
    Longatti P, Fiorindi A, Martinuzzi A, Feletti A (2009) Primary obstruction of the fourth ventricle outlets: neuroendoscopic approach and anatomic description. Neurosurgery 65:1078–1085CrossRefPubMedGoogle Scholar
  33. 33.
    Marin-Sanabria EA, Yamamoto H, Nagashima T, Kohmura E (2007) Evaluation of the management of arachnoid cyst of the posterior fossa in pediatric population: experience over 27 years. Childs Nerv Syst 23:535–542CrossRefPubMedGoogle Scholar
  34. 34.
    Martinoni M, Toni F, Lefosse M, Pozzati E, Marliani AF, Mascari C (2014) Endoscopic treatment of a fourth ventricle arachnoid cyst via the third ventricle: a case report. Neurosurgery 10:E374–E378CrossRefPubMedGoogle Scholar
  35. 35.
    Messerer M, Nouri M, Diabira S, Morandi X, Hamlat A (2009) Hearing loss attributable to a cerebellopontine-angle arachnoid cyst in a child. Pediatr Neurosurg 45:214–219CrossRefPubMedGoogle Scholar
  36. 36.
    Nomura S, Akimura T, Imoto H, Nishizaki Suzuki M (2002) Endoscopic fenestration of posterior fossa arachnoid cyst for the treatment of presyrinx myelopathy. Case report. Neurol Med Chir (Tokyo) 42:452–454CrossRefGoogle Scholar
  37. 37.
    Nowosławska E, Polis L, Kaniewska D, Mikołajczyk W, Krawczyk J, Szymański W, Zakrzewski K, Podciechowska J, Polis B (2006) Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods. Childs Nerv Syst 22:599–604CrossRefPubMedGoogle Scholar
  38. 38.
    Oertel JM, Baldauf J, Schroeder HW, Gaab MR (2009) Endoscopic cystoventriculostomy for treatment of paraxial arachnoid cysts. J Neurosurg 110:792–799CrossRefPubMedGoogle Scholar
  39. 39.
    Oertel JM, Wagner W, Mondorf Y, Baldaus J, Schroeder HW, Gaab MR (2010) Endoscopic treatment of arachnoid cysts: a detailed account of surgical techniques and results. Neurosurgery 67:824–836CrossRefPubMedGoogle Scholar
  40. 40.
    Olaya JE, Ghostine M, Rowe M, Zouros A (2011) Endoscopic fenestration of a cerebellopontine angle arachnoid cyst resulting in complete recovery from sensorineural hearing loss and facial nerve palsy. J Neurosurg Pediatr 7:157–160CrossRefPubMedGoogle Scholar
  41. 41.
    Ottaviani F, Neglia CB, Scotti A, Capaccio P (2002) Arachnoid cyst of the cranial posterior fossa causing sensorineural hearing loss and tinnitus: a case report. Eur Arch Otorhinolaryngol 259:306–308PubMedGoogle Scholar
  42. 42.
    Ozek MM, Urgun K (2013) Neuroendoscopic management of suprasellar arachnoid cysts. World Neurosurg 79(2 Suppl):S19.e13-18Google Scholar
  43. 43.
    Pascual-Castroviejo I, Roche MC, Martínez Bermejo A, Arcas J, García Blázquez M (1991) Primary intracranial arachnoidal cysts. A study of 67 childhood cases. Childs Nerv Syst 7:257–263CrossRefPubMedGoogle Scholar
  44. 44.
    Raju S, Sharma RS, Moningi S, Momin J (2015) Neuroendoscopy for intracranial arachnoid cysts in infants: therapeutic considerations. J Neurol Surg A Cent Eur NeurosurgGoogle Scholar
  45. 45.
    Reganchary SS (1981) Parasagittal arachnoid cyst: case report. Neurosurgery 9:70–75CrossRefGoogle Scholar
  46. 46.
    Santamarta D, Aguas J, Ferrer E (1995) The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 38:133–137CrossRefPubMedGoogle Scholar
  47. 47.
    Schroeder HW, Gaab MR, Niendorf WR (1996) Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85:293–298CrossRefPubMedGoogle Scholar
  48. 48.
    Schroeder HW, Gaab MR (1997) Endoscopic observation of a slit-valve mechanism in suprasellar prepontine arachnoid cyst: case report. Neurosurgery 40:198–200PubMedGoogle Scholar
  49. 49.
    Sengul G, Tuzun Y, Cakir M, Duman S, Colak A, Kadioglu HH, Aydin IH (2012) Neuroendoscopic approach to quadrigeminal cistern arachnoid cysts. Eurasian J Med 44:18–21CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Shim KW, Lee YH, Park EK, Park YS, Choi JU, Kim DS (2009) Treatment option for arachnoid cysts. Childs Nerv Syst 25:1459–1466CrossRefPubMedGoogle Scholar
  51. 51.
    Spennato P, Ruggiero C, Aliberti F, Buonocore MC, Trischitta V, Cinalli G (2013) Interhemispheric and quadrigeminal cysts. World Neurosurg 79(2 Suppl):S20.e1-7PubMedGoogle Scholar
  52. 52.
    Tamburrini G, D'Angelo L, Paternoster G, Massimi L, Caldarelli M, Di Rocco C (2007) Endoscopic management of intra and paraventricular CSF cysts. Childs Nerv Syst 23:645–651CrossRefPubMedGoogle Scholar
  53. 53.
    Teo C, Kadrian D, Hayhurst C (2013) Endoscopic management of complex hydrocephalus. World Neurosurg 79(2 Suppl):S21.e1-7PubMedGoogle Scholar
  54. 54.
    Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D (2004) Neuroendoscopic surgery of intracranial cysts in adults. Childs Nerv Syst 20:842–851CrossRefPubMedGoogle Scholar
  55. 55.
    Torres-Corzo J, Sánchez-Rodríguez J, Cervantes D, Rodríguez-Della Vecchia R, Muruato-Araiza F, Hwang SW, Rangel-Castilla L (2014) Endoscopic transventricular transaqueductal Magendie and Luschka foraminoplasty for hydrocephalus. Neurosurgery 74:426–435CrossRefPubMedGoogle Scholar
  56. 56.
    Wang C, Han G, You C, Liu C, Wang J, Xiong Y (2013) Individual surgical treatment of intracranial arachnoid cyst in pediatric patients. Neurol India 61:400–405CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Alberto Feletti
    • 1
    Email author
  • Matteo Alicandri-Ciufelli
    • 1
  • Giacomo Pavesi
    • 1
  1. 1.Unit of Neurosurgery, Department of NeurosciencesNOCSAE Modena HospitalBaggiovara (MO)Italy

Personalised recommendations