Treatment of septum pellucidum cysts by CT-guided puncture and cystoperitoneal shunt: Report of 12 cases / 中国微创外科杂志

Objective To explore the feasibility of CT-guided puncture and cystoperitoneal shunt in the treatment of septum pellucidum cysts.Methods Twelve patients with symptomatic septum pellucidum cysts were treated by CT-guided puncture and cystoperitoneal shunt.There were 8 patients with accompanying hydrocephalus.Before operation,routine coronal CT scans were carried out to determine the relationship between the center of the cyst and the baseline.Results Symptoms of headache and dizziness disappeared in all the 12 patients.No recurrence of epileptic attack was found in 3 patients with epileptic history.Clear consciousnesss was observed in 2 patients with loss of consciousnesss.All the 12 patients were followed for 2~36 months(mean,11 months).Postoperative CT and MRI examinations showed that the cyst disappeared in 10 patients and decreased in size in 2 patients(the maximum diameter decreased by 3~18 mm,with a mean of 12.6 mm).The enlarged ventricle in 8 patients with hydrocephalus was 30% or more smaller than that before operation.All the patients were discharged from hospital without any complications.Conclusions CT-guided puncture and cystoperitoneal shunt in the treatment of symptomatic sepeum pellucidum cysts is feasible and it has advantages of minimally invasion,simple to perform,less complications.

A Huge Posterior Fossa Arachnoid Cyst with Cervicothoracic Syringomyelia

The authors report a surgically treated patient with very unusual combination of a giant posterior fossa cyst in cerebellopontine area, Chiari I malformation and syringomyelia in cervico-thoracic area. Ventricles were not dilated. He complained weakness and clumsiness on the right upper extremity. His symptom was attributable to the syringomyelia of cervical spinal cord. The authors managed this patient by removing the arachnoid cyst and cystoperitoneal shunt on the assumption that this cyst has an influence on the formation of Chiari malformation and syringomyelia. After operation there was marked improvement in the motor power in the arm, and a follow-up MRI one month later showed a disappearance of syringomyelia. The authors believe that this very unusual condition is of interest in making the pathogenesis of syringomyelia clear.

Management of Intracranial Arachnoid Cysts

The authors have operated on fifteen cases of intracranial arachnoid cyst during the last 4 years. Among them, eleven cases of middle cranial fossa arachnoid cyst have undergone uniformly cystoperitoneal shunt. The craniotomy and fenestration(open surgery) was performed in three cases which located in quadrigeminal cistern(1 case) and harvored other combined problems(2 cases, intracystic hemorrhage and exophthalmos due to defect of lateral orbital wall respectively). A case of intraventricular arachnoid cyst was managed by ventriculocystostomy. All of above procedures showed good clinical and radiological results with acceptable morbidity and no mortality. With these observation, we thought as follows : 1) In middle cranial fossa cysts, cystoperitoneal shunt is sufficient as the first choice of operative intervention because it revealed good results with low morbidity and negligible complications. 2) Open surgery seems to be indicated only in deep seated cyst around brainsterm where the introduction of shunt catheter is difficult and dangerous and in cyst combinind other problems necessitating surgical intervation also.

Treatment and Outcome of Intracranial Arachnoid Cysts

Sixty-four patients with intracranial arachnoid cyst were treated at the Department of Neurosurgery, Yonsei University college of medicine between 1985 and 1992. Among them, forty-eight patients received operation, The purpose of this study was to review our surgical results and find out the most effective surgical procedure for arachnoid cyst in each location. The thirty-one patients with the supratentorial arachnoid cyst showed the mass effect or subdural hematoma on preoperative CT scan. They were treated with marsupialization, cystoperitoneal shunt, fenestration with cystoperitoneal shunt, and cystoperitoneal shunt with endoscopy. The fenestration with cystoperitoneal shunt showed the best result in supratentorial arachnoid cysts. The ten patients with the midline arachnoid cyst showed the hydrocephalus on CT scan. They were treated with open fenestration with ventriculoperitoneal shunt, endoscopic fenestration. open fenestration, endoscopic fenstration with ventriculoperitoneal shut and cystoperitoneal shunt. The endoscopic fenestration showed the best result in midline arachnoid cysts. The seven patients infratentorial arachnoid cysts also presents with hydrocephauls on intial CT scan. The open fenestration with ventriculoperitoneal shunt, open fenestr- ation,endoscopic fenestration, and cystoperitoneal shunt were surgical procedure for these. The cystoperitoneal shunt showed the best result in infratentorial arachnoid cysts. The complications of treatment related with shunt operation, were relieved with shunt revision. Forty-five cases among forty-eight operated cases had good clinical outcome. The most appropriate surgical method for arachnoid cyst were discussed.

A Case of the Suprasellar Arachnoid Cyst

We report a case of the suprasellar arachnoid cyst with hydrocephalus which was incidental finding after minor head injury. Preoperatively, we studied the CT cisternography through lumbar route with niopam. It revealed that the arachnoid cyst was communicated with ventricles and delayed filling and clearance pattern of the cyst. The suprasellar arachnoid cyst with hydrocephalus was treated by combined craniotomy with partial removal of the membrane wall and cystoperioneal shunt. We reviewed the literature and discussed the diagnosis and treatment of the suprasellar arachnoid cyst.