Hydrocephalus and Arachnoid Cysts
The prevalence of intracranial arachnoid cysts (ACs) in children is comprised between 1% and 3%. Most of them are asymptomatic and no treatment is needed.
ACs can be divided into seven types: suprasellar, temporal, intraventricular, quadrigeminal, posterior fossa, convexity, and interhemispheric.
History, pathophysiology, epidemiology, clinical presentation, radiological diagnosis, classifications, association with hydrocephalus, surgical management and techniques, their outcome, and complications are discussed.
Three main techniques are available: open microsurgery, cyst and/or ventriculoperitoneal shunting, and endoscopic fenestration or a combination of these techniques.
Suprasellar, intraventricular, and quadrigeminal ACs appear to be the best indications for endoscopic fenestration with better outcome because of their position in the midline, in intimate relationships with the basal cisterns and ventricles. For a durable endoscopic treatment, the key point is to perform the largest and more fenestrations as possible, allowing a better restoration of cerebrospinal fluid (CSF) pathways. Cortical cysts seem to be best treated by open microsurgery or shunting. Shunt implantation showed a high rate of complications such as malfunctions, shunt dependency, slit cyst syndrome, or chronic tonsillar herniation that can be severe but appears to be the best treatment when indications are well chosen.
When ACs are symptomatic or if hydrocephalus is present, the best treatment remains to create communications between the cyst and normal CSF cisterns or ventricles, each time it is possible with the best mini-invasive single procedure. The amendment of neuroendoscopy tends to treat most of ACs, but microsurgical and shunting procedures still keep a place in selected cases.
KeywordsArachnoid cyst Hydrocephalus Endoscopy Shunt Suprasellar Quadrigeminal Interhemispheric Temporal Slit cyst syndrome Chronic tonsillar herniation
Anatomical Nomenclature of Figures
Anterior communicant artery
Basal membrane of the arachnoid cyst
Foramen of Monro
Great cerebral vein
- I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII
Internal carotid artery
Internal cerebral vein
Inferior petrosal sinus
Middle cerebral artery
Middle cranial fossa
- med. obl.
Posterior cerebral artery
Posterior communicant artery
- Petr. bone
We gratefully acknowledge Dr LISTRAT Antoine from Clocheville Pediatric Hospital of Tours, Dr SPENNATO Pietro, Dr ALIBERTI Ferdinando, Dr RUGGIERO Claudio and Dr MIRONE Giuseppe from Santobono Children’s Hospital of Naples for their continuous support during production of this chapter by providing operative pictures and for their criticisms and suggestions.
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