Aim
The management of arachnoid cysts (AC) remains controversial. An additional problem derives from the management of hydrocephalus associated with an AC. In this work, we discuss existing procedures proposed in the current literature for their treatment.

Hydrocephalus and arachnoid cysts

The feasibility of single isocenter, multi-arc non-coplanar volumetric modulated arc therapy (VMAT) for multiple brain tumors was studied using an Elekta Synergy linear accelerator with an Agility multileaf collimator and a Monaco treatment planning system. Two VMAT radiosurgery plans consisting of a full arc and three half arcs were created with a prescribed dose of 20 Gy in a single fraction. After dose delivery to a phantom, ionization chambers and radiochromic films were used for dose measurement. The first VMAT radiosurgery plan had nine targets inside the phantom, and the doses were measured by the chambers at two different points and by the films on three sagittal and three coronal planes. The differences between the calculated dose and the dose measured by a Farmer ionization chamber and a pinpoint ionization chamber were <1.00% and <2.30%, respectively, and the average pass rates of gamma indices among the six planes under each of 3%/3 mm and 2%/2 mm criteria were 98.6% and 92.6%, respectively. The second VMAT radiosurgery plan was based on a clinical 14 brain metastases. Differences between calculated and film-measured doses were evaluated on two sagittal planes. The average pass rates of the gamma indices on the planes under each of 3%/3 mm and 2%/2 mm criteria were 97.8% and 88.8%, respectively. It was confirmed that single-isocenter, non-coplanar multi-arc VMAT radiosurgery for multiple brain metastases was feasible using Elekta Synergy with Agility and Monaco treatment planning systems. It was further shown that film dosimetry was accurately performed for a dose of up to nearly 25 Gy.

Feasibility of single-isocenter, multi-arc non-coplanar volumetric modulated arc therapy for multiple brain tumors using a linear accelerator with a 160-leaf multileaf collimator: a phantom study

Object Arachnoid cysts are congenital lesions that arise during development by splitting of the arachnoid membrane. Large cysts can be adjacent to CSF pathways causing a marked midline shift and hydrocephalus. The association between a large arachnoid cyst and hydrocephalus has been commonly described as being due to a mass effect, but these previous reports have not focused closely on any associated intraventricular abnormalities. Methods Seven patients who were previously treated with a cystoperitoneal shunt presented with shunt failure, hydrocephalus, and/or cyst expansion. All of these patients had giant arachnoid cysts extending to the periventricular region from the original site, which was the sylvian fissure in 4 patients, and the suprasellar cistern, quadrigeminal cistern, and interhemispheric fissure in 1 patient each. Endoscopic exploration of the ventricular system and cyst fenestration was then performed in all patients. Results The endoscopic findings were obstruction of the cerebral aqueduc...

Coexistent intraventricular abnormalities in periventricular giant arachnoid cysts.

Less than 0.5% of arachnoid cysts are intraventricular in origin. We review our experience with endoscopic surgery for intraventricular arachnoid cysts in children. This is a retrospective review of children with intraventricular arachnoid cysts who underwent surgery between 2005 and 2016. Clinical notes and imaging were reviewed. 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. 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.

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

Treatment of symptomatic interhemispheric arachnoid cysts by cystoperitoneal shunting

Object. Interhemispheric arachnoid cysts are very rare, and they are often associated with complex brain malformations such as corpus callosum agenesis and hydrocephalus. Debate remains concerning the proper management of these lesions. Placement of shunts and microsurgical marsupialization of the cyst are the traditional options. Using endoscopic methods to create areas of communication between the cyst, the ventricular system, and/or the subarachnoid space is an attractive alternative to the use of shunts and microsurgery. Methods. Between 2000 and 2005, seven consecutive pediatric patients with interhemispheric arachnoid cysts underwent neuroendoscopic treatment involving cystoventriculostomy in two patients, cystocisternostomy in two, and cystoventriculocisternostomy in three. There were three cases of associated hydrocephalus, six cases of corpus callosum agenesis, and one case of corpus callosum hypogenesis. The follow-up period ranged from 12 to 49 months (mean 31.6 months). Endoscopic procedures were completely successful in all but two patients. In one of the remaining two patients, a repeated endoscopic cystocisternostomy was performed with success because of closure of the previous stoma. In the other, a subcutaneous collection of cerebrospinal fluid (CSF) was managed by insertion of an lumboperitoneal shunt. A subdural collection of CSF developed in three patients; it was treated with insertion of a subduroperitoneal shunt in one patient and managed conservatively in the other two patients, resolving spontaneously without further treatment. Neurodevelopmental evaluation performed in six patients showed normal intelligence (total intelligence quotient [IQ] . 80) in three patients, mild developmental delay (total IQ 50‐80) in two, and severe developmental delay (total IQ , 50) in one. Conclusions. Endoscopic treatment of interhemispheric cysts can be considered a useful alternative to traditional treatments, even if some complications are to be expected, such as subdural or subcutaneous CSF collections and CSF leaks due to thinness of cerebral mantle and to the often-associated multifactorial hydrocephalus.

Neuroendoscopic management of interhemispheric cysts in children

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Neuroendoscopic management of interhemispheric cysts in children

Neuroendoscopic management of interhemispheric cysts in children