Endoscopic surgery for intraventricular arachnoid cysts in children: clinical presentation, radiological features, management, and outcomes over a 12-year period

Childs Nerv Syst. 2018 Feb;34(2):257-266. doi: 10.1007/s00381-017-3524-9. Epub 2017 Jul 17.


Purpose: Less than 0.5% of arachnoid cysts are intraventricular in origin. We review our experience with endoscopic surgery for intraventricular arachnoid cysts in children.

Methods: This is a retrospective review of children with intraventricular arachnoid cysts who underwent surgery between 2005 and 2016. Clinical notes and imaging were reviewed.

Results: Twenty-nine patients with endoscopically treated intraventricular arachnoid cysts were identified (M/F = 17:12; median age = 1.47 years, range = 7 days-13 years). All had hydrocephalus at presentation, many had symptoms/signs of raised intracranial pressure, and five (17%) were asymptomatic. Cysts were treated with fenestration into the ventricle alone (ventriculocystostomy [VC], n = 14), fenestration into the ventricle and cisternostomy (ventriculocystostomy plus cisternostomy [VC + C], n = 14), or endoscopic third ventriculostomy alone (n = 1). Six (21%) patients experienced transient and/or conservatively managed complications. Further surgery was required in 12 (41%). Revision-free survival was significantly shorter with VC compared to VC + C (log rank p = 0.049), and the majority of VC/VC + C revisions (n = 8 of 11, 73%) were required within 6 months of initial endoscopic surgery. One (3%) patient died during follow-up, from unrelated pathology. After a median follow-up of 67.5 months in survivors (range = 5.5-133.5 months), 24 (83%) cases were clinically and radiologically stable without a shunt in situ.

Conclusions: Endoscopic fenestration is safe and effective in most intraventricular arachnoid cysts. Additional cisternostomy at the time of cyst fenestration into the ventricle significantly improved revision-free survival in our cohort. Endoscopic surgery should be the first-line therapy when considering intervention for symptomatic intraventricular arachnoid cysts and for asymptomatic cysts increasing in size on serial imaging.

Keywords: Cisternostomy; Endoscopic fenestration; Intraventricular arachnoid cyst; Ventriculocystocisternostomy; Ventriculocystostomy.

MeSH terms

  • Adolescent
  • Arachnoid Cysts / diagnostic imaging*
  • Arachnoid Cysts / surgery*
  • Cerebral Ventricles / diagnostic imaging*
  • Cerebral Ventricles / surgery*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disease Management*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neuroendoscopy / methods
  • Neuroendoscopy / trends*
  • Retrospective Studies
  • Time Factors
  • Ventriculostomy / methods
  • Ventriculostomy / trends