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Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series.

Srinivasan US, Lawrence R - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved.We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India.

ABSTRACT

Introduction and aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.

Materials and methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973-2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.

Results: In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.

Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.

No MeSH data available.


Related in: MedlinePlus

Summary of the surgical strategy for the posterior fossa arachnoid cyst
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Figure 5: Summary of the surgical strategy for the posterior fossa arachnoid cyst

Mentions: Hence in summary, we propose the surgical strategy with which we can achieve excellent long term results for these PFACs. The surgical strategy for Midline extra-fourth ventricular cyst [Figure 2], Lateral CP angle cyst [Figure 3] and lateral retro-cerebellar cyst/intra-cerebellar cyst [Figure 4] is microsurgical excision of the cyst wall, which can be safely performed with excellent long term outcome. The treatment strategy for midline intra-fourth ventricular/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst [Figure 5]. All our cases were followed-up for a minimum period of 3 years and maximum 12 years which to our knowledge it is one of the longest follow-up series of such type of PFAC cases in adults reported in literature.


Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series.

Srinivasan US, Lawrence R - Asian J Neurosurg (2015 Jan-Mar)

Summary of the surgical strategy for the posterior fossa arachnoid cyst
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352631&req=5

Figure 5: Summary of the surgical strategy for the posterior fossa arachnoid cyst
Mentions: Hence in summary, we propose the surgical strategy with which we can achieve excellent long term results for these PFACs. The surgical strategy for Midline extra-fourth ventricular cyst [Figure 2], Lateral CP angle cyst [Figure 3] and lateral retro-cerebellar cyst/intra-cerebellar cyst [Figure 4] is microsurgical excision of the cyst wall, which can be safely performed with excellent long term outcome. The treatment strategy for midline intra-fourth ventricular/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst [Figure 5]. All our cases were followed-up for a minimum period of 3 years and maximum 12 years which to our knowledge it is one of the longest follow-up series of such type of PFAC cases in adults reported in literature.

Bottom Line: Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved.We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India.

ABSTRACT

Introduction and aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.

Materials and methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973-2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.

Results: In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.

Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.

No MeSH data available.


Related in: MedlinePlus