Biomedical Engineering Reference
In-Depth Information
Keywords Arachnoid cyst Neuro endoscopic Endoscopic treatment
Introduction
The optimal surgical treatment for symptomatic arachnoid cysts is controversial.
Therapeutic options include cyst shunting [ 1 - 5 ], endoscopic fenestration [ 6 - 11 ],
and craniotomy for fenestration [ 12 - 14 ]. Endoscopy is having an increasingly
prominent role in neurosurgery. The endoscopic procedure has been found to be
minimally invasive, safe, and effective as compared to the traditional surgical
craniotomy [ 15 - 20 ]. We are reporting our experience of endoscopic treatment of
21 arachnoid cysts.
Material and Methods
All the symptomatic patients of arachnoid cysts except one were operated by
endoscopic procedure between Jan 2004 and Feb 2008. One patient of convexity
cyst without any adjoining cistern/ventricle was managed by cystoperitoneal shunt
was was excluded from study. There were a total of 21 patients. Detailed history
and thorough physical examination was done. CT scans were done in all the cases.
MRI scans were done in 19 cases. Gaab 6-degree rigid telescope (Karl Storz
Germany) was used. Burr hole was placed at most superior point on the skull. This
prevents entry of air in the cyst cavity. Presence of air in cyst cavity hampers
proper visualization. Burr hole margins were drilled in such a way as to allow
straight trajectory from the cyst to the cistern or the ventricle. Cruciate incision
was made in the dura mater as small as possible but sufficient enough to pass a
telescope. Hitch stitches taking dura mater and arachnoid cyst were applied to
prevent separation of dura mater from bone. This also prevents separation of dura
mater from cyst wall. Large-sized dural incision should be avoided as it allows
entry of air which hampers proper endoscopic visualization. Cyst wall adjoining
the cistern or the ventricle was coagulated and cut to make free communication
taking care not to injure any vessel or cranial nerve. Communication between cyst
and cistern is usually made parallel to the vessel or nerve. A minimum of 1 cm
hole was made in all the patients.
Results
This was a prospective study of 21 arachnoid cysts. There were 14 male patients.
There were 6 cases of inferior vermian region, 8 cases of quadrigeminal region,
5 of sylvian fissure region, and 2 of cerebello-pontine region cysts. Symptomatic
Search WWH ::




Custom Search