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Alejandro Vargas-Moreno1, Oscar Gutierrez2, Rene Alvarez-Berastegui2
  1. Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia,
  2. Department of Neurosurgery, Hospital Santa Clara ESE, Bogotá, Colombia.

Correspondence Address:
Alejandro Vargas-Moreno, Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.

DOI:10.25259/SNI_80_2022

Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Alejandro Vargas-Moreno1, Oscar Gutierrez2, Rene Alvarez-Berastegui2. Pure endoscopic management of a middle fossa Galassi III arachnoid cyst. 18-Mar-2022;13:95

How to cite this URL: Alejandro Vargas-Moreno1, Oscar Gutierrez2, Rene Alvarez-Berastegui2. Pure endoscopic management of a middle fossa Galassi III arachnoid cyst. 18-Mar-2022;13:95. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11456

Date of Submission
19-Jan-2022

Date of Acceptance
17-Feb-2022

Date of Web Publication
18-Mar-2022

Abstract

Background: Microsurgical and endoscopic approaches are accepted alternatives for the management of symptomatic arachnoid cyst. However, given their ability to visualize critical neurovascular structures with less morbidity, less dissection needs, and high success rates, endoscopic approaches are excellent options for the management of this pathology.

Case Description: We present the case of an otherwise healthy 8-year-old male who presented with a chronic history of disabling headache that augmented with exercise and interrupted his sleep. He had a normal neurological examination. Neuroimaging studies depicted a right middle fossa Galassi III arachnoid cyst with no associated hydrocephalus, marked displacement of adjacent cortex, and apparent connection with the basal cisterns. Given the severity of the symptoms, and the size and compressive effect of the arachnoid cyst, surgical management through and endoscopic approach was undertaken. We performed a right temporal burr hole, right above the zygomatic arch to avoid vessels of the Sylvian fissure and to allow an optimal trajectory to the medial edge of the cyst and the target cisterns. We proceeded to identify the endoscopic anatomy of the surrounding structures to perform and adequate fenestration of multiple arachnoid membranes, obtaining an adequate cystocisternal communication. We then performed closure in a standard fashion. The patient was neurologically unchanged after the procedure and was discharged on postoperative day 2. The postoperative images revealed a dramatic reduction in the cyst dimensions with resolution of its compressive effect.

Conclusion: Endoscopic management of arachnoid cyst offers several advantages such as the visualization of the cyst boundaries and critical adjacent structures, and the need for a less extensive dissection having a success rate between 83% and 92%. It is important to perform a wide multifocal fenestration as a key step to avoid cyst reclosure.

Keywords: Endoscopic, Arachnoyd cyst, Pediatric

Video 1

Annotations[1-6]

00:00–00:22 – Clinical presentation

00:22–00:37 – Preoperative imaging

00:37–00:51 – Rationale of treatment

00:51–1:51 – Patient positioning and procedure explanation

1:51–2:35 – Endoscopic middle fossa anatomy description

2:35–5:15 – Procedure video

5:15–5:30 – Postoperative imaging and outcome

5:30 – Discussion.

Declaration of patient consent

Patient’s consent not required as patient identity is not disclosed or compromised.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

References

1. Azab WA, Almanabri M, Yosef W. Endoscopic treatment of middle fossa arachnoid cysts. Acta Neurochir (Wien). 2017. 159: 2313-7

2. Cinalli G, Spennato P, Di G, Mirone G, Cascone D.editors. Endoscopic Treatment of Arachnoid Cysts. 2016. p. 179-99

3. Couvreur T, Hallaert G, van der Heggen T, Baert E, Dewaele F, Okito JP. Endoscopic treatment of temporal arachnoid cysts in 34 patients. World Neurosurg. 2015. 84: 734-40

4. Greenfield JP, Souweidane MM. Endoscopic management of intracranial cysts. Neurosurg Focus. 2005. 19: E7

5. Inoue K, Seker A, Osawa S, Alencastro LF, Matsushima T, Rhoton AL. Microsurgical and endoscopic anatomy of the supratentorial arachnoidal membranes and cisterns. Neurosurgery. 2009. 65: 644-64

6. Oertel JM, Wagner W, Mondorf Y, Baldauf J, Schroeder HW, Gaab MR. Endoscopic treatment of arachnoid cysts: A detailed account of surgical techniques and results. Neurosurgery. 2010. 67: 824-36

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