Article
Frame-based stereotactic cysto-ventricular shunt implantation for treatment of acquired intracerebral cysts
Rahmenbasierte stereotaktisch geführte Implantation von zysto-ventrikulären Shunts zur Behandlung erworbener intrazerebraler Zysten
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Published: | June 4, 2021 |
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Objective: The treatment of symptomatic, progressive or recurrent acquired intracerebral cysts is challenging especially when localized in eloquent or deep-seated midline structures. Hereby, the frame-based stereotactic implantation of cysto-ventricular shunts offers a minimally invasive and highly precise technique. Here we evaluated the feasibility and efficacy of this technique in patients with acquired intracerebral cysts of different origins.
Methods: In this single center retrospective analysis, we included all patients with acquired intracerebral cysts who underwent frame-based stereotactically guided internal cysto-ventricular shunt implantation between 2012 and 2020. Patient data were analyzed in terms of clinical symptom control, unexpected side effects and radiological outcome concerning cyst volume reduction (3D volumetry).
Results: Thirty-five patients (f/m =18/17, median age 43 years, range 2-77 years) were identified. Median cyst volume before treatment was 11.6 cm3 (range 1.6-71.6 cm3) and mean follow-up was 21 months (range 0-82 months). At last follow-up, a mean reduction of cyst volume of 73.3% could be achieved. Initial symptoms improved or were completely regressive in 49% of cases (n=17) and remained stable in 40% (n=14). No permanent clinical deterioration after treatment was observed. Three patients required surgical catheter revision due to shunt obstruction or infection.
Conclusion: In our analysis, stereotactic internal cysto-ventricular shunting proves to be a safe and effective surgical method with excellent long-term control of cyst volume, clinical improvement and a lack of severe permanent side effects. Therefore, this technique offers an alternative to endoscopic or microsurgical approaches as a first-line treatment in patients with acquired intracerebral cysts of different entities.