Article
Mesencephalic ependymal cysts: surgical technique and clinical outcome
Ependymale Zysten des Mesencephalon: operative Strategie und klinisches Ergebnis
Search Medline for
Authors
Published: | May 4, 2005 |
---|
Outline
Text
Objective
Ependymal or epithelium-lined cysts of the mesencephalon are rare lesions that usually occur with symptoms of an occlusive hydrocephalus or symptoms like Parinaud's syndrome, dizziness or long tract symptoms. The objective of this retrospective study is an evaluation of the surgical technique for the treatment of these cysts and the clinical outcome of the patients.
Methods
The clinical records of eight patients treated for symptomatic mesencephalic ependymal cysts in the last ten years in our department were studied retrospectively. The patient age ranged from 22 to 60 years with a mean age of 44 years. The group consisted of seven women and one man. Four patients had been operated on using a suboccipital infratentorial supracerebellar approach in an endoscope-assisted microsurgical technique, the other four patients underwent a purely endoscopic procedure over a frontal burr hole trepanation. The keyhole concept was applicable to both techniques.
Results
In all of the patients, an adequate fenestration of the cyst was achieved. Four patients were symptom-free, the other four improved significantly after a mean follow-up duration of 38.5 months (range 5 to 119 months). One patient underwent two operations: ventriculocystostomy and four months later an endoscopic third ventriculostomy because of recurrent hydrocephalus. In one case a second surgical procedure was necessary because of a wound infection. The patients were aböe tp leave the hospital during the first week after surgery.
Conclusions
Mesencephalic ependymal cysts can be treated successfully and most likely permanently by a purely endoscopic or endoscope-assisted keyhole neurosurgical technique. There was no morbidity or mortality related to these procedures in this group of eight patients. Because of these results, we regard the described surgical procedures to be a great alternative to treatments such as shunting (ventriculoperitoneal and -atrial, cystocisternal) or stereotactic aspiration of the cysts.