Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children--a clinical entity difficult to detect on neuroimaging study

Slit ventricle syndrome, known to occur from malfunction of the shunt procedure for hydrocephalus, is reported after cyst-peritoneal shunt for temporal arachnoid cyst. Two children aged 12 and 10 years, who underwent cyst-peritoneal shunting for a large temporal arachnoid cyst at the age of 10 and 5 years, respectively, recently experienced several episodes of severe headache. Prior to admission, repeated CT scans did not reveal any morphological change in either of these two patients. Evidence of high intracranial pressure by lumbar tap revealed shunt malfunction. Both patients became free of neurological complaints and deficits after shunt revision. Despite elevated intracranial pressure due to shunt malfunction, neuroimaging studies showed no morphological changes in slit ventricle syndrome. Delay in both the diagnosis and prompt treatment may result in complete loss of visual acuity and even death. It is important to suspect this complication in patients with persistent elevated intracranial pressure symptoms and signs after any shunting procedure, regardless of unchanged neuroimaging studies. Once this is suspected, lumbar tap may be necessary and the choice of treatment is shunt revision.     

囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿358例

目的 研究分析囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿的方法及其有效性和安全性.方法 采用囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿358例,术前主要根据影像学结果选择不同的分流管,在显微镜下完成囊腔内的置管过程.结果 颅内蛛网膜囊肿颞窝的发生率为60.6%,1年内手术有效率为97.2%,术后分流管阻塞率为1.7%,术后感染率为1.1%.结论 囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿安全有效,具有操作简单、对脑组织干扰小等特点.     

The use of an adjustable valve to treat over-drainage of a cyst-peritoneal shunt in a child with a large sylvian fissure arachnoid cyst

Introduction The cyst-peritoneal shunt is a recognised surgical alternative in the management of sylvian fissure arachnoid cysts. Shunt overdrainage is well described in literature on ventriculo-peritoneal shunts, but not often appreciated as a complication of cysto-peritoneal shunts.Case report A 5-year-old boy presented with a symptomatic left sylvian fissure arachnoid cyst. This was initially treated by craniotomy and membrane fenestration in the carotid cistern. Recurrence led to insertion of a valveless cyst-peritoneal shunt 5 months later. Initial progress was followed by persistent headaches 18 months after shunt insertion. CT scan revealed a significant reduction in the cyst size, enlargement of the ipsilateral lateral ventricle, collapse of the contra-lateral ventricle and midline shift towards the side of the shunt. These findings were interpreted as over-drainage of the cyst-peritoneal shunt.Result A Codman Medos adjustable valve was inserted, with the intention of gradually increasing the pressure until the midline shift was restored and the contra-lateral ventricle was reconstituted. This was achieved with the valve set at 90 mm H₂O, verified by CT scan. Radiological improvement was associated with dramatic symptomatic improvement.Conclusion Over-drainage of cyst-peritoneal shunts is often not appreciated, especially when the main manifestation is headaches. As it is difficult to predict the required valve pressure setting, it may be advisable to consider the use of an adjustable valve.The material of this paper was presented as a poster at the 31st Annual Meeting of the International Society for Pediatric Neurosurgery, Monaco, 14–18 September 2003     

Slit ventricle syndrome after cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst

Serious complications following installation of a cyst-peritoneal shunt in an 8-year-old boy with asymptomatic arachnoid cyst in the middle cranial fossa are reported. Highly elevated intracranial pressure without association of ventriculomegaly seen in this patient indicates slit ventricle syndrome caused by malfunction of the cyst-peritoneal shunt. This phenomenon is worth recognizing as a possible consequence of cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst.     

Pseudotumor syndrome in treated arachnoid cysts

We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism — specifically, a disturbance of the cerebrospinal fluid circulation.     

颅内蛛网膜囊肿的手术方法研究

目的 探讨颅内蛛网膜囊肿的手术治疗方法 . 方法 回顾性分析68例手术治疗的颅内蛛网膜囊肿患者的临床资料,根据手术方式不同,分为4组:囊肿切除术17例(A组).囊肿-脑池沟通术25例(B组),囊肿-腹腔分流术20例(C组),脑立体定向手术6例(D组),对4种手术方式的疗效进行比较. 结果 术后随访3月以上,59例患者症状消失或改善,有效率86.8%.CT证实囊肿消失或缩小者51例(75.0%).术后发生颅内积气2例、颅内出血3例、伤口感染2例.不同术式比较:影像学有效率A组为11/17(64.7%),B组为21/25(84.0%),C组为15/20(75.0%),D组为4/6(66.7%);症状改善率为A组12/17(70.6%),B组22/25(88.0%),C组19/20(95.0%),D组6/6(100%).A组7例患者术后头痛,发生比例较高. 结论 对颅内蛛网膜囊肿应慎重选择手术适应证和手术时机.从安全性和微侵袭角度,绝大多病例应首选囊肿-腹腔分流术.     

Functional assessment of intracranial arachnoid cysts with TC99 m-HMPAO SPECT: a preliminary report

Background Many arachnoid cysts (AC) are detected incidentally in asymptomatic patients. Current neuroimaging methods provide only morphological details of the cysts, but they do not give information about cerebral function. While surgery is indicated in symptomatic patients, the management of asymptomatic individuals, who present with large cysts, is controversial.Study objective To ascertain the value of cerebral 99 mTc-HMPAO single photon emission computed tomography (SPECT) for detecting brain dysfunction in cases of intracranial ACs, aimed at allocating the patients for surgical or for conservative treatment.Patients and methods We studied prospectively 11 patients diagnosed with sylvian fissure ACs. The subjects underwent neurological examination, EEG, neuroimaging studies, neuropsychological testing, and cerebral perfusion studies with 99 mTc-HMPAO SPECT.Results The patients’ ages ranged from 2 to 42 years (median 16 years). The study group consisted of ten symptomatic patients with ACs and one patient with an incidental cyst. Seven patients showed diminished regional cerebral blood flow (rCBF) in their initial cerebral SPECT. Four individuals underwent surgery. Seven patients showed normalization of rCBF after surgical or conservative treatment.Conclusions Cerebral SPECT demonstrated impaired brain perfusion in 70% of symptomatic patients. The zone of decreased rCBF corresponded well with clinical symptoms and with neuroimaging findings. Patients exhibiting normal rCBF in SPECT studies remained or became asymptomatic during the follow-up time. Cerebral SPECT constitutes a valuable adjunct tool for correlating regional function with brain anatomy, and may be of help to allocate patients with ACs for surgical treatment or clinical observation. Further research on this field is warranted.     

儿童蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征的治疗

目的 探讨颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现的裂隙脑室综合征的早期诊断依据,合理有效的治疗方法以及预防这种并发症的措施.方法 回顾性分析研究了经过本文通信作者治疗的6例颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现裂隙脑室综合征患儿的影像学资料、治疗经过和治疗结果.结果 男4例,女2例.平均发病年龄57.5个月.治疗方法为使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合使用脑室-腹腔分流.6例患者临床症状完全消失,平均随访30个月,未见症状复发.结论 使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合脑室-腹腔分流术对于裂隙脑室综合征是一种有效的治疗措施.避免使用低压的无抗虹吸作用的分流管能够有效地预防蛛网膜囊肿-腹腔分流术后出现裂隙脑室综合征.

Abstract：

Objective To investigate early diagnosis evidences, optimal therapeutic strategies and the prophylactic methods of the slit - ventricle syndrome(SVS) in the temporal lobe arachnoid cysts patients who received the cyst - peritoneal(CP) shunting.Method Six cases of SVS in the temporal lobe arachnoid cysts patients who received the CP shunting were treated by the senior author from Jan 2005 to Jan 2009.The radiological data, treatment process and therapeutic results were reviewed retrospectively.Results There were 4 male and 2 female patients.The mean age of presentation was 57.5 months.The final treatment was to change the original shunt with the programmable valve or combined with the ventricular - peritoneal(VP)shunting.All the symptoms of the patients disappeared totally, and the mean follow - up duration was 30mouths.Conclusions To use programmable shunts to substitute for the original shunt or combined with inserting a VP shunt is an optimal therapeutic method for SVS.The use of low - pressure shunts to treat the ararchoid systs should be abandoned unless dictated by specific indications.     

儿童颅内蛛网膜囊肿的外科干预

目的 探讨小儿颅内蛛网膜囊肿的治疗方法.方法 收治15岁以下颅内蛛网膜囊肿患者37例,其中手术切除囊肿壁同时打通颅底蛛网膜池12例,囊肿-腹腔分流术20例,神经内镜造瘘术5例.对患者术后症状体征改善、影像学囊肿变化以及术后并发症等进行回顾性对比分析.结果 37例患者神经系统症状和体征均有不同程度的改善.影像学随访结果表明无论是哪种方法均能够使囊肿有不同程度的缩小,脑组织膨隆比较理想.改善情况并未因手术方式的不同而存在明显的差异(P>0.05).但开颅手术组并发症发生率明显高于分流组和神经内镜组.结论 囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿具有近期效果明显和并发症少的优点.

Abstract：

Objective Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1 % of all intracranial space-occupying lesions.So far, the optimal method of treatment for symptomatic arachnoid cysts remains controversial.In this article,we want to find an ideal technique to deal with this condition.Method The hospital records of 37 consecutive patients with intracranial arachnoid cysts who were treated in Tianjin Huanhu Hospital between January 2004 and December 2009, were analyzed retrospectively.All the patients were children below the age of 15 years old with an average of 6, 7 years old.The diagnosis of arachnoid cyst was based on computerized tomography (CT) and MRI scan findings demonstrating a well-circumscribed and non-enhancing cystic lesion that had attenuation values similar to those of the cerebrospinal fluid ( CSF) and did not communicate with the ventricular system.They were divided into three groups as follow, group A ( 12 patients ) , open craniotomy; group B ( 20 patients ) , cyst-peritoneal shunting, and group C(5 patients), endoscopic fenestration.Results The symptoms and neurological signs were improved more or little in all the 3 group patients who accepted the neurosurgical treatment.There were no significant differences between among the 3 groups in releasing of the symptom and sign caused by cysts.On the other hand,there were high percentage of complications,including intracranial infections and subdural fluid collections in the group A.Conclusions The technique of cysto-peritoneal shunting is likely the optimal method for treating the intracranial arachnoid cysts in children.     

Hypothalamic hamartoma associated with an arachnoid cyst.

A hypothalamic hamartoma associated with an arachnoid cyst in an 8-year-old boy is reported herein. He presented with precocious puberty, and neuroimaging studies demonstrated a solid mass in the prepontine cistern and a huge arachnoid cyst in the left cranial fossa. The mass appeared isointense to the surrounding cerebral cortex on T1-weighted magnetic resonance images, hyperintense on T2-weighted images, and was not enhanced after administration of Gd-DTPA. The patient underwent a left frontotemporal craniotomy and a cyst-peritoneal shunt was inserted. Histological features of the cyst wall and the mass were characteristic of an arachnoid cyst and hamartoma, respectively. While a hypothalamic hamartoma associated with an arachnoid cyst is rare, such a case may help clarify the geneses of both anomalous lesions.     

Shunt dependency syndrome after cystoperitoneal shunting of arachnoid cysts

Purpose

The goal of this study was to investigate the mechanisms, diagnosis, and treatment of shunt dependency syndrome in patients with temporal lobe arachnoid cysts who were initially treated with cystoperitoneal (CP) shunting.

Methods

Thirteen patients with temporal lobe arachnoid cysts who had initially been treated with CP shunt placement and had developed shunt dependency syndrome were treated by the senior author at Tiantan Hospital between April 2010 and January 2012. The clinical manifestations, neuroimaging findings, intracranial pressure (ICP) data, treatment methods, and therapeutic results were reviewed retrospectively.

Results

The study included ten males and three females. The mean age at the time of development of shunt dependency syndrome was 12.3 years (range 5.5–24 years). In most patients, neuroimaging findings showed a collapsed cyst (the cyst appeared almost unchanged in only one patient) and normal or small ventricles (only one patient had enlarged ventricles). Three patients underwent simple replacement of the shunt, four underwent ventriculoperitoneal shunt placement, and the other six underwent lumboperitoneal shunt placement. All patients experienced resolution of their symptoms postoperatively. The mean duration of follow-up was 20 months.

Conclusions

Shunt dependency syndrome is a rare but serious complication of shunting an arachnoid cyst. This condition is similar to the slit ventricle syndrome, but also has some differences. ICP monitoring may confirm the diagnosis when there are no significant radiological findings. Achievement of a shunt-free state might be the ultimate goal for all shunted patients.     

The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus

The programmable Medos Hakim valve offers the possibility of adjusting the valve's operating pressure noninvasively. We retrospectively analyzed a series of 78 children who underwent a shunting procedure using this programmable valve within the last 4 years: 46 children underwent a primary shunt placement and 32 children underwent a shunt revision with a different valve replaced by the Medos programmable valve. There were 23 complications, 9 infections, 13 mechanical complications and 1 subileus in all children. Treatment was successful with no need for further shunt revision in 29 of the children with primary shunt placements and 27 of the children with shunt revisions. In 10 cases of overdrainage this was adequately corrected by readjustment of the valve operating pressure alone. As there are no criteria for prediction of the valve operating pressure needed for any individual patient we consider this valve to be beneficial in various forms of shunt-dependent pediatric hydrocephalus.     

An evaluation of the surgical treatment of intracranial arachnoid cysts in children

In the period 1976–1987, the number of intracranial arachnoid cysts treated at our institute was 60: sylvian, 29; midline supratentorial, 13; subtentorial, 18. The diagnosis was mainly made by means of the results of a combination of CT, dynamic cisternography, and ventriculography. Based on an analysis of the preoperative investigations and operative results, an attempt was made to determine the appropriate treatment more precisely in cysts at different locations. The direct microsurgical approach with membrane excision was mainly used in combination with a preliminary VA shunt to treat hydrocephalus. The direct approach was supplemented with secondary cavity shunting in 5 cases. In more than half of the patients we used membrane excision alone (mainly children with sylvian cysts). In suprasellar cysts we consider the subfrontal approach to be more appropriate than the transventricular one. We restricted the use of primary cyst shunting as an alternative treatment to only 3 infants, with huge cysts. The follow-up reveals that 82.7% of the cases were favorably affected to varying degrees.This work was partially supported by a grant to Dr. Marinov from the Alexander von Humboldt Foundation, Bonn, Federal Republic of GermanyPresented at the 11th Meeting of the European Society for Paediatric Neurosurgery, Naples 1988     

Endoscopic approach to arachnoid cyst

A prospective study of 36 consecutive patients with congenital arachnoid cysts treated endoscopically is reported. There were 15 female and 21 male patients. The mean age at the time of diagnosis was 12.3 years (10 days to 38 years). Arachnoid cysts were located in the suprasellar region in 16 patients, the sylvian fissure in 11, the quadrigeminal cistern in 4 and the posterior fossa in 5. Endoscopic fenestration was combined with cysto-peritoneal shunting for 6 temporal cysts and with ventriculo-peritoneal shunting in 1 suprasellar cyst. Mean postoperative follow-up was 4.2 years (range 1–8 years). Follow-up imaging studies showed that 28 arachnoid cysts (77.8%) were obliterated after endoscopic procedures. Long-term clinical results were good in all patients, although the cysts of 8 patients were not reduced in size. There was no mortality or morbidity. We conclude that endoscopic procedures may be a promising alternative to microsurgical operations or shunting for the treatment of arachnoid cysts. Received: 30 December 1998     

颅内蛛网膜囊肿的临床诊治（附22例报告）

目的探讨颅内蛛网膜囊肿的临床诊治。方法回顾分析手术治疗22例颅内蛛网膜囊肿患者临床资料,术式包括蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术及囊肿-腹腔分流术等。结果17例获得良好疗效,6例癫痫患者5例症状消失。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿囊壁切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。     

颅内蛛网膜囊肿临床治疗分析

目的探讨颅内蛛网膜囊肿(IAC)的临床特征和治疗方法。方法IAC患者53例,其中47例行手术治疗,术式包括微创囊肿切除加局部的蛛网膜下腔及相关脑池开放术、蛛网膜囊肿部分切除术及囊肿-腹腔分流术等;6例未手术者临床随访观察。结果大部手术治疗者获得良好疗效,癫痫能得到控制或发作次数减少。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,蛛网膜囊肿部分切除加局部蛛网膜下腔及相关脑池开放术是首选的外科方法。     

Neonatal anterior cervical arachnoid cyst: case report and review of the literature

OBJECTIVE: Anterior cervical arachnoid cysts are rare in the pediatric population, with only 16 cases reported. We present the first case of an anterior cervical arachnoid cyst in a neonate and review the literature on pediatric cervical arachnoid cysts. CLINICAL PRESENTATION: A 16-day-old baby girl with a history of myelomeningocele repair progressively developed symptoms of upper extremity weakness over the course of 2 weeks. Magnetic resonance imaging (MRI) demonstrated a compressive arachnoid cyst extending from C2 to C7. INTERVENTION: The child was taken for posterior cervical laminoplasty and cyst fenestration. Intraoperatively, diffuse cervical arachnoiditis was noted. Rapid improvement in upper extremity paresis was noted within 24 h of surgery, and MRI confirmed decompression of the cyst. However, flaccid upper extremity paresis recurred within 2 weeks. MRI confirmed recurrence of the anterior cervical arachnoid cyst. The child was taken for a secondary fenestration and stenting of the cyst. Only partial improvement in arm function was noted by 1 month following reoperation. CONCLUSION: Arachnoid cysts can be effectively treated with surgical fenestration, shunting, and complete or partial excision. Rapid identification and treatment results in improvement in myelopathic symptoms; however, the most efficacious treatment modality remains unknown. Of the 17 cases of anterior cervical arachnoid cysts reported in the literature, 11 (65%) have had either prior myelomeningocele repair or a history of spinal trauma. Anterior cervical arachnoid cysts should be considered in the differential diagnosis of acute onset myelopathy in the pediatric population especially in cases with a history of spinal trauma or myelomeningocele repair.     

Brain glucose utilisation in acquired childhood aphasia associated with a sylvian arachnoid cyst: recovery after shunting as demonstrated by PET.

Regional brain glucose utilisation was investigated with PET and fluorodeoxyglucose (FDG) in a case of epileptic aphasia (Landau-Kleffner syndrome) associated with a left sylvian arachnoid cyst. CT and MRI had failed to disclose any mass effect of the cyst on surrounding brain structures. Sequential metabolic measurements showed a comparable pronounced hypometabolism in cortical regions around the cyst, involving speech areas, and suggested mild but chronic compression of the developing brain. After placement of a cyst-peritoneal shunt system, significant metabolic improvement occurred in all cortical regions, especially the inferior frontal gyrus and the perisylvian area, with predominant residual deficit in the left superior temporal gyrus. These findings were correlated with a pronounced increase in word fluency and slower progress in verbal auditory comprehension. This report suggests that PET is able to evaluate the functional disturbances associated with expanding arachnoid cysts, and to follow the neurological improvement after drainage.     

Differential diagnosis and origin of epithelial cysts in the central nervous system--report of seven cases and review of literature

Seven cases of epithelial cysts are presented with special reference to histological findings. Differential diagnosis and origin of the cysts are also discussed. Two are autopsy cases and 5 are surgical cases. Median age of the patients is 41 years. Three cysts are in the posterior fossa, 1 in the supratentorial region, 1 in both infra- and supratentorial regions and 2 in the spinal canal. On light microscopy, the type of cell lining the cyst wall and the presence of cilia and PAS-positive cells are studied. All cyst walls were lined by a single layer of cuboidal to columnar epithelium. Cilia was seen in 1 and PAS-positive cells were found in 5 out of 7 cases. On electron microscopy of the 4 cases available for study, continuous basement membrane and microvilli were observed in all cases. Coating material covering microvilli was noted in 2 cases. According to these histological findings, these cysts are classified as follows: 1 multiloculated cyst, 1 (respiratory) epithelial cyst, 3 (enterogenous) epithelial cysts, 1 ependymal lined cyst and 1 neuroectodermal cyst. Various non-neoplastic cystic lesions are found in the central nervous system, such as arachnoid cyst, ependymal cyst, colloid cyst, choroid epithelial cyst, neurenteric cyst, and Rathke's cleft cyst. Although histological difference between arachnoid cyst and other epithelium-lined cysts is relatively clear, the precise discrimination between other cystic lesions is difficult and controversial. Some authors have considered these cysts as a neuroectodermal origin because of their histological similarity with choroid plexus or ependyma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endoscopic management of intra and paraventricular CSF cysts

Background The management of intra- and paraventricular lesions is one of the fields in which modern neuroendoscopic techniques have given the most significant contribution in terms of reduction in operative invasiveness and postoperative complications. In this context, fluid cysts represent an ideal ground on which results obtained with traditional surgical procedures (open surgery, shunting) have more and more to compare with the increasing number of encouraging results obtained by neuroendoscopy. Objective The objective of this study was to retrospectively evaluate the results of the endoscopic treatment of intra- and paraventricular cysts performed at our institution and how they compare with what has been reported in the literature, concerning the results of open surgery, shunting, and endoscopic management. Materials and methods All the patients with intra- and paraventricular cerebrospinal fluid (CSF) cysts endoscopically managed at our institution between March 2000 and October 2006 were included. Based on cyst location documented by magnetic resonance imaging (MRI), the cohort of patients examined was subdivided in five groups: A, paraventricular cysts; B, choroids plexuses cysts; C, secondary intraventricular cysts in previously hydrocephalus shunted patients; D, quadrigeminal cistern arachnoid cysts; and E, suprasellar arachnoid cysts. The neuroendoscopic procedures were performed with a 30° rigid endoscope (Storz Decq, 3.8 mm). The surgical plan and best trajectory were selected on preoperative MR imaging. Postoperatively, all patients underwent CT scans in the first 48 h after surgery and MR control 3 months after surgery. Results There were 26 patients (18 M/8F). The mean age at diagnosis was 8.95 years. Five of 26 cases were adult patients. Four patients had paraventricular cysts; 2 patients had a choroids plexuses cyst; 6 patients a secondary intraventricular cyst in previously shunted hydrocephalus; 11 patients had a quadrigeminal cistern arachnoid cyst and 3 patients had a suprasellar arachnoid cyst. Fifteen patients had an associated hydrocephalus at the time of the surgical treatment (one patient in group A, six patients in group C, six in group D, and two in group E). Twenty-three out of 26 patients underwent endoscopic management of their cystic lesion as primary procedure; in the remaining three cases, it represented a secondary procedure after open cyst marsupialization or/and the implant of a cystoperitoneal shunt. Endoscopic management consisted in a cystoventriculostomy (CV) in 19 patients. Third ventriculostomy (ETV) was associated to CV in seven cases, and it was performed at the same time of the CV procedure in all these cases. There was no mortality, neither operative morbidity. At a mean follow-up of 2.15 years (0.1–4 years), a complete resolution of preoperative clinical symptoms and signs was recorded in 80.9% of symptomatic patients. Control MRI showed a reduced cyst size in 25/26 patients and a stable cyst size in the last case, with signs of CSF flow between the cyst and the cerebral ventricles in all cases. One out of 15 patients with associated hydrocephalus had a persistent ventriculomegaly without signs of increased intracranial pressure. Conclusions Our results confirm that endoscopic management of intra- and paraventricular cysts is a valid alternative to open surgery as well as to shunting procedures. Control of clinical symptoms and signs was obtained in around 80% of our patients, while radiological evidence of cyst size reduction occurred in more than 95% of them. These rates are comparable with results of open surgery and shunting. The main advantage of neuroendoscopy is the low incidence of complications, a result that is confirmed by the present series. Presented at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), Marburg, Germany, 15–18 June 2005.