Article
Endoscopic fenestration of intraventricular cerebrospinal fluid cysts: The contralateral approach
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Published: | May 21, 2013 |
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Objective: The endoscopic fenestration of space-occupying ventricular cysts, as an alternative to cystoperitoneal shunting, has evolved into a well-accepted treatment option. However, a transcortically performed approach can cause cortical injury with subsequent neurological deficits, especially in patients with dominant-sided lesions. Objective of this study was to examine the value of the contralateral transcortical transventricular endoscopic approach in patients with dominant-sided ventricular cysts.
Method: A retrospective chart review was performed in all patients with intraventricular cystic lesions, operated by the senior author. Clinical symptoms, radiological data and operative results were evaluated.
Results: During a five-year period between 2007 and 2011, 31 patients were operated with intraventricular non-colloidal arachnoidal or ependymal cysts. 14 cysts were located on the dominant side. After meticulous planning of optimal endoscopic trajectory, 11 patients were operated via a contralateral navigation-guided transcortical transventricular approach. Follow-up data were available for all 11 patients, showing correct fenestration and no recurrent cysts over a mean period of 2 years and 3 months. Postoperative clinical outcome was excellent without permanent neurological or neuropsychological morbidity.
Conclusions: The endoscopic contralateral approach to intraventricular cystic lesions avoids approach related trauma of the dominant hemisphere. Clinical and radiological results in our series were excellent. Anatomical precondition was a suitable ventricular configuration with 1.) approachable ventricular width on the subdominant side and 2.) possible penetration of the cyst to the contralateral dominant side. Technical precondition was the intraoperative use of neuro-navigation for optimal trajectory finding.