Biomedical Engineering Reference
In-Depth Information
the same sitting. In some cases hydrocephalus could be due to co-existing
aqueductal stenosis, apart from the pressure due to cyst. Many researchers also
advocated the endoscopic procedure as the primary procedure in arachnoid cysts
in most cases because it is a minimally invasive procedure. The traditional
surgical treatment can be performed without additional risk if endoscopic surgery
fails [
33
-
37
]. Cerebro-spinal fluid leak was the only complication in this series.
Results of endoscopic treatment of suprasellar arachnoid cysts were very good
[
38
-
45
]. The outcome of endoscopic treatment of quadrigeminal cistern region
arachnoid cyst was also good [
46
-
48
]. Similar good results in other location cysts
like cerebello-pontine angle and posterior fossa cysts were also observed [
28
].
Abbott [
49
] and Strojnik [
22
] also predicted that most of the arachnoid cysts will
be managed endoscopically in the future.
Endoscope-controlled microsurgery is a valid minimally invasive procedure for
treating superficially located intracranial arachnoid cysts [
50
]. Arachnoid cyst can
be successfully treated with the help of navigation. As the anatomical landmarks
are not visible in some cases, navigated endoscopic procedures help in correct
placement of communications between cyst and ventricle or cistern [
38
,
51
].
Although endoscopic management of arachnoid cyst [
6
-
11
,
52
], hydrocephalus
[
53
-
56
], brain abscess [
57
,
58
], intra ventricular hemorrhage [
59
], atlanto-axial
dislocation [
60
], deep intra cerebral hematoma [
61
],and trigeminal neuralgia [
62
]
is becoming the preferred and effective method because of its minimal invasive
nature and safety, it also has some limitations. Normal anatomical landmarks are
not visible, so the orientation may be a problem in some cases. Navigation is very
helpful in such cases Follow-up is short in this study. This procedure may be
possible if cyst is not in the vicinity to cistern or ventricle. Straight trajectory is
needed for rigid scope, which may be difficult in some cases, to make commu-
nication between the cyst and cistern or the ventricle. This problem can be
overcome by flexible endoscope. Air can enter inside the superficial cyst which
may hamper proper visualization.
References
1. Gomez Escalonilla CI, Garcia Morales I, Galan Davila L, Gimenez-Torres MJ, Simon-Heras
R, Valencia J, Mateos-Beato F (2001, 2002) Intracranial arachnoid cysts. A study of a series
of 35 cases. Comment in: Rev Neurol 34(1):98, Rev Neurol 33(4):305-311
2. McBride LA, Winston KR, Freeman JE (2003) Cystoventricular shunting of intracranial
arachnoid cysts. Pediatr Neurosurg 39(6):323-329
3. Helland CA, Wester K (2006) Arachnoid cysts in adults: long-term follow-up of patients
treated
with
internal
shunts
to
the
subdural
compartment.
Surg
Neurol.
66(1):56-61
(discussion 61)
4. Germano A, Caruso G, Caffo M, Baldari S, Calisto A, Meli F, Tomasello F (2003) The
treatment of large supratentorial arachnoid cysts in infants with cyst-peritoneal shunting and
Hakim programmable valve. Childs Nerv Syst 19(3):166-173 (Epub 2003 Feb 13)
5. Hamid NA, Sgouros S (2005) 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. Childs Nerv Syst.
21(11):991-994 (Epub 2005 Jan 8)
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