Endoscopic management of intra and paraventricular CSF cysts |
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Authors: | G Tamburrini L D’Angelo G Paternoster L Massimi M Caldarelli C Di Rocco |
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Institution: | (1) Pediatric Neurosurgical Unit, Catholic University Medical School, Largo A. Gemelli, 8, 00168 Rome, Italy |
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Abstract: | 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. |
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Keywords: | CSF cyst Arachnoid Ventricular Endoscopy |
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