Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts: Clinical article

Daniel H. Fulkerson, Todd D. Vogel, Abdul A. Baker, Neal B. Patel, Laurie L. Ackerman, Jodi Smith, Joel C. Boaz

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Object. The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts. Methods. The authors performed a retrospective review of 79 consecutive patients (1993-2010) with surgically treated intracranial arachnoid cysts. Results. The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years. Conclusions. Posterior fossa cyst-ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.

Original languageEnglish
Pages (from-to)549-556
Number of pages8
JournalJournal of Neurosurgery: Pediatrics
Volume7
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Arachnoid Cysts
Salvage Therapy
Stents
Cysts
Catheters
Headache
Pressure
Lateral Ventricles
Morbidity
Incidence

Keywords

  • Arachnoid cyst
  • Posterior fossa
  • Stent
  • Ventricle

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts : Clinical article. / Fulkerson, Daniel H.; Vogel, Todd D.; Baker, Abdul A.; Patel, Neal B.; Ackerman, Laurie L.; Smith, Jodi; Boaz, Joel C.

In: Journal of Neurosurgery: Pediatrics, Vol. 7, No. 5, 05.2011, p. 549-556.

Research output: Contribution to journalArticle

Fulkerson, Daniel H. ; Vogel, Todd D. ; Baker, Abdul A. ; Patel, Neal B. ; Ackerman, Laurie L. ; Smith, Jodi ; Boaz, Joel C. / Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts : Clinical article. In: Journal of Neurosurgery: Pediatrics. 2011 ; Vol. 7, No. 5. pp. 549-556.
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abstract = "Object. The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts. Methods. The authors performed a retrospective review of 79 consecutive patients (1993-2010) with surgically treated intracranial arachnoid cysts. Results. The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years. Conclusions. Posterior fossa cyst-ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.",
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