gms | German Medical Science

Objective: Since the development of neuroendoscopy, pure endoscopic fenestration has become more and more popular for arachnoid cyst treatment and is preferred by many authors. The objective is to evaluate the authors’ experiences with endoscopic treatment of arachnoid cysts over a 22-year period.

Method: Between February 1993 and June 2015, a total of 92 endoscopic procedures in 86 patients was performed and retrospectively analyzed. Depending on the anatomy and flow in preoperative images of the cysts, cystocisternostomies, ventriculocystostomies, cystoventriculostomies and ventriculocystocisternostomies were performed. Special attention was given to surgical complications, patients’ outcome and radiological benefit in relation to cyst localization and endoscopic technique.

Results: A total of 92 endoscopic arachnoid cyst fenestrations were performed in 86 patients. Cyst location was temporobasal (38,4%), paraxial supratentorial (16,3%), suprasellar (15,1%), at the cisterna quadrigemina (12,8%), infratentorial (12,8%), and intraventricular supratentorial (4,7%). Four different endoscopic procedures were performed: cystocisternostomies (50,0%), ventriculocystostomies (20,7%), cystoventriculostomies (18,5%) and ventriculocystocisternostomies (10,9%). Pure endoscopic technique was feasible in 93,5%. Clinical improvement was documented in 85,9%, radiological benefit in 72,8%. Recurrences developed in 7,6%. Overall postoperative complication rate was 18,5% (15,2% transient complications, 2,2% new shunt dependence, and 1,1% permanent complications). Of the various locations, suprasellar and intraventricular cysts reached the highest clinical and radiological success rates (100% each) and the lowest complication rates (7,7%, respectively 0%). Ventriculocystostomy and ventriculocystocisternostomy reached the highest success rates of the procedures (clinical: 100% each; radiological: 94,7%, respectively 100%). Temporobasal cysts were the most frequent ones with low success rates (clinical: 81,8%, radiological: 60,6%), highest recurrence rate (15,2%), and highest complication rate (24,2%).

Conclusions: In the authors’ opinion, endoscopic treatment is the method of choice for arachnoid cysts. It is a safe and minimally invasive technique, which provides good results with low complication rates. The most frequent temporobasal cysts are the most difficult to treat endoscopically. Because recurrences can occur many years after first treatment, a long-term follow-up is recommended.