Abstract
Purpose
The aim of this study is for the surgical treatment and outcome of the endoscopic fenestration of the arachnoid cyst located in the ventricular body to trigone in the pediatric population. Special concern was paid for the developmental origin of the intraventricular cysts estimated from the postoperative follow-up neuroimagings.
Patients and methods
Between July 2002 and June 2015, we performed endoscopic and partly CT/MRI navigated fenestrations of intraventricular arachnoid cysts located at the body to trigone of the lateral ventricle in ten pediatric patients aged 2 months to 5 years. Based on the long axis of the cyst, we have opted for two surgical approaches: anterior approach via burr hole at Kocher’s point and posterior approach via burr hole at the posterior occipital region. Fenestration was performed based on the intraoperative findings, either ventriculocystostomy, ventriculocystoventriculostomy, or ventriculocystocisternostomy.
Results
Intraventricular arachnoid cysts located in the body-trigone region showed a favorable outcome after endoscopic fenestration. All of the cysts shrank postoperatively. Follow-up neuroimagings taken between 6 and 126 months after surgery strongly suggested its relationship with the midline cisterns. Of our ten cases, eight were suggestive for originating from the velum interpositum cistern while two seemed to root from the quadrigeminal cistern.
Conclusion
In the present study, we found that endoscopic fenestration of intraventricular arachnoid cysts in the body to trigone is a safe procedure with a satisfactory outcome. In our limited experience, there are two anatomic backgrounds; velum interpositum cistern and quadrigeminal cistern. Differentiation can be possible by neuroimagings, especially those obtained after surgery.
Similar content being viewed by others
References
Adeeb N, Deep A, Griessenauer CJ, Mortazavi MM, Watanabe K, Loukas M, Tubbs RS, Cohen-Gadol AA (2013) The intracranial arachnoid mater: a comprehensive review of its history, anatomy, imaging, and pathology. Childs Nerv Syst 29:17
Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO (2010) Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatrics 5:578–585
Ali M, Bennardo M, Almenawer SA, Zagzoog N, Smith AA, Dao D, BHSc, Ajani O, Farrokhyar F, Singh SK (2015) Exploring predictors of surgery and comparing operative treatment approaches for pediatric intracranial arachnoid cysts: a case series of 83 patients. J Neurosurg Pediatr 12:1–8
Basaldella L, Orvieto E, Dei Tos AP, Della Barbera M, Valente M, Longatti P (2007) Causes of arachnoid cyst development and expansion. Neurosurg Focus 22(2):E4
Boockvar JA, Shafa R, Forman MS, O’Rourke DM (2000) Symptomatic lateral ventricular ependymal cysts: criteria for distinguishing these rare cysts from other symptomatic cysts of the ventricles: case report. Neurosurgery 46:1229–1233
Cappabianca P, Cappabianca P, Cinalli G, Gangemi M, Brunori A, Cavallo LM, de Divitiis E, Decq P, Delitala A, Di Rocco F, Frazee J, Godano U, Grotenhuis A, Longatti P, Mascari C, Nishihara T, Oi S, Rekate H, Schroeder HW, Souweidane MM, Spennato P, Tamburrini G, Teo C, Warf B, Zymberg ST (2008) Application of neuroendoscopy to intraventricular lesions. Neurosurgery 62(Suppl 2):575–598
Cinalli G, Spennato P, Cianciulli E, D’Armiento M (2004) Hydrocephalus and aqueductal stenosis. In: Cinalli G, Maixner WJ (eds) Saint-Rose C Pediatric hydrocephalus. Springer, Milan, pp. 279–293
Cinalli G, Spennato P, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, et al. (2007) Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23(6):633–644
Cinalli G, Spennato P, Columbano L, Ruggiero C, Aliberti F, Trischitta V, et al. (2010) Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases. J Neurosurg Pediatrics 6:489–497
D’Addario V, Pinto V, Rossi AC, Pintucci A, Di Cagno L (2009) Cavum veli interpositi cyst: prenatal diagnosis and postnatal outcome. Ultrasound Ostet Gynecol 34:52–54
Funaki T, Makino Y, Arakawa Y, Hojo M, Kunieda T, Takagi Y, et al. (2012) Arachnoid cyst of the velum interpositum originating from tela choroidea. Surg Neurol Int 3:120
Gaab MR, Schroeder HW (1999) Neuroendoscopic approach to intraventricular lesions. Neurosurg Focus 6:E5
Gallassi E, Tognetti F, Gaist G, Fagioli L, Frank F, Frank G (1982) CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol 17:363
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(2):158–164
Gangemi M, Maiuri F, Colella G, Sardo L (1999) Endoscopic surgery for intracranial cerebrospinal fluid cyst malformations. Neurosurg Focus 6(4):E6
Greenfield JP, Souweidane MM (2005) Endoscopic management of intracranial cysts. Neurosurg Focus 19:E7
Giussani C, Fiori L, Trezza A, Riva M, Sganzerla EP (2011) Cavum veli interpositi: just an anatomical variant or a potentially symptomatic CSF compartmentalization? Pediatr Neurosurg 47:364–368
Hervey-Jumper SL, Ziewacz JE, Heth JA, Sullivan SE (2010) Frontal- to-temporal horn shunt as treatment for temporal horn entrapment. J Neurosurg 112:410–413
Levy ML, Wang M, Aryan HE, Yoo K, Meltzer H (2003) Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 53:1138–1144
Maurice-Williams RS, Choksey M (1986) Entrapment of the temporal horn: a form of focal obstructive hydrocephalus. J Neurol Neurosurg Psychiatry 49:238–242
Oertel JM, Wagner W, Mondorf Y, Baldauf J, Schroeder HW, Gaab MR (2010) Endoscopic treatment of arachnoid cysts: a detailed account of surgical techniques and results. Neurosurgery 67:824–836
Park SW, Yoon SH, Cho KH, Shin YS (2006) A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern - case report. Surg Neurol 65:611–614
Pradilla G, Jallo G (2007) Arachnoid cysts: case series and review of the literature. Neurosurg Focus 22:E7
Pawar SJ, Sharma RR, Mahapatra AK, Dev EJ (2001) Giant ependymal cyst of the temporal horn - an unusual presentation. Case report with review of the literature. Pediatr Neurosurg 34:306–310
Ross DA, Muraszko K, Dauser R (1994) A special cyst puncture catheter for use in thick-walled or mobile intracranial cysts. Neurosurgery 34:191–192
Schulz M, Bohner G, Knaus H, Haberl H, Thomale UW (2010) Navigated endoscopic surgery for multiloculated hydrocephalus in children. J Neurosurg Pediatr 5:434–442
Silav G, Sarı R, Bölükbaşı FH, Altaş M, Işık N, Elmacı İ (2015) Microsurgical fenestration and cystoperitoneal shunt through preauricular subtemporal keyhole craniotomy for the treatment of symptomatic middle fossa arachnoid cysts in children. Childs Nerv Syst 31:87–93
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 23:645–651
Yoshioka S (2014) Intracranial cystic disease: a review. Nerv Syst Children 37:398–408 Japanese
Acknowledgements
The clinical fellowship of BK at TMCMC was supported by the Carl Zeiss scholarship from the German Society of Neurosurgery.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest declared by the authors.
Informed consent
For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Knie, B., Morota, N., Ihara, S. et al. Pediatric intraventricular arachnoid cysts in the body of lateral ventricle: surgical outcome and its embryologic background. Childs Nerv Syst 32, 2197–2204 (2016). https://doi.org/10.1007/s00381-016-3203-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-016-3203-2