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Endoscopic cyst fenestration is an advanced technique that has the benefits of fenestration without requiring open surgery, combined with the simplicity of shunting without the risk of shunt complications. It’s a short, safe procedure in which the neurosurgeon uses an endoscope (a type of tube with a camera), to drain the cyst internally.
The three most common surgical treatments for arachnoid cysts in the brain are craniotomy fenestration, endoscopic cyst fenestration, or shunt placement. The nonsurgical treatment is close observation of the cyst.
Endoscopic cyst fenestration is an advanced technique with the benefits of fenestration without requiring open surgery. It’s a short, safe procedure in which a neurosurgeon uses an endoscope (a type of tube with a camera) to drain the cyst internally.
Pediatric neurosurgeon, Eric M. Jackson, discusses endoscopic fenestration as an alternative to cystoperitoneal shunting in an infant with a massive intracranial cyst.
An image-guided endoscopic cyst fenestration via the contralateral transcortical transventricular approach was performed in 11 patients. A retrospective chart review was performed in all these patients to extract data on clinical presentation, operative technique, and surgical outcome.
Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used.
We described cystocisternostomy technique for arachnoid cysts through fenestration medial to the edge of tentorium through lateral pontomesencephalic membrane and illustrated it's outcomes.
Microscopic fenestration through a craniotomy is the first option for large arachnoid cysts in young children while endoscopic technique through a small burr hole should be reserved for relatively small arachnoid cysts presented with seizure in adults.
Many authors have been regarded endoscopic fenestration as the first option of treatment 1, 5, 6, 8, 12, 18, 20, 21). To treat AC, fenestrations need to be definite and large enough to communicate the cyst and intact cisternal spaces freely without re-closure.
Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years.