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Hydrocephalus and Arachnoid Cysts

  • François Lechanoine
  • Giuseppe Cinalli
Living reference work entry

Later version available View entry history

Abstract

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.

Keywords

Arachnoid cyst Hydrocephalus Endoscopy Shunt Suprasellar Quadrigeminal Interhemispheric Temporal Slit cyst syndrome Chronic tonsillar herniation 

Anatomical Nomenclature of Figures

3V

Third ventricle

4V

Fourth ventricle

AC

Anterior commissure

AcoA

Anterior communicant artery

Aq.

Aqueduct

BA

Basilar artery

BM

Basal membrane of the arachnoid cyst

BV

Basal vein

Cereb.

Cerebellum

Ch.

Optic chiasm

ChP

Choroid plexus

clivus

CN

Caudate nucleus

Cyst

Falx

flocc.

Flocculus

FM

Foramen of Monro

GCV

Great cerebral vein

Hipp.

Hippocampus

I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII

Cranial nerves

ICA

Internal carotid artery

ICV

Internal cerebral vein

Inf.

Infundibulum

insula

IPS

Inferior petrosal sinus

JB

Jugular bulb

LT

Lamina terminalis

LV

Lateral ventricle

MB

Mamillary bodies

MCA

Middle cerebral artery

MCF

Middle cranial fossa

med. obl.

Medulla oblongata

Mid.

Midbrain

MN

Mixes nerves

PC

Posterior commissure

PCA

Posterior cerebral artery

PCli

Posterior clinoid

PcoA

Posterior communicant artery

Petr. bone

Petrous bone

pons

PS

Pituitary stalk

SP

Septum pellucidum

Tent.

Tentorium

Notes

Acknowledgment

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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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryHôpital Bretonneau, CHRU de ToursToursFrance
  2. 2.Division of Pediatric Neurosurgery and Department of NeurosciencesSantobono-Pausilipon Children’s HospitalNaplesItaly

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