SURGICAL VIDEO Endoscopic Fenestration of a Giant Midline Arachnoid Cyst: 3-Dimensional Operative Video ∗ ∗ Antonio D’Ammando, MD , Francesco Doglietto, MD, PhD , Francesco Belotti, MD, Claudio Cereda, MD, Marco Maria Fontanella, MD Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy These authors contributed equally to this work. Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ opx207 Intracranial arachnoid cysts are benign developmental collec- tions of cerebrospinal fluid that account for approximately 1% of intracranial masses. basilar, posterior cerebral, and posterior communicating arteries Endoscopic fenestration of intracranial arachnoid cysts is a together with both third cranial nerves. Anteriorly, the pituitary well-known, relatively recent surgical option. This video shows gland and stalk were clearly seen together with the superior the use of a high-definition 3-dimensional ventriculoscope for hypophyseal arteries and dorsum sellae. As the chiasm and optic treatment of a giant midline arachnoid cyst. nerves were anteriorly displaced, the left ophthalmic artery was This 7-yr-old boy presented with a movement disorder of also visible. the head (ie, side-to-side bobbling of the head–bobble-head doll The endoscope was then moved to the level of the basilar artery. syndrome), at first considered a simple motor tic, 2 years before A fenestration was performed and enlarged at the level of the being evaluated in our clinic. No endocrine dysfunctions, visual inferiorly displaced Liliequist membrane; the left sixth cranial disorders, or other neurological deficits were observed. nerve and both vertebral arteries came into view. Brain magnetic resonance imaging (MRI) documented a giant The patient experienced immediate resolution of symptoms midline cyst, extending from the prepontine region to the corpus and remains well, with no clinical signs of intracranial hyper- callosum, markedly displacing the pituitary stalk and chiasm tension or papilledema. anteriorly and the midbrain posteriorly. Follow-up MRI documented a marked reduction in cyst The patient was placed in a supine position with slight head volume. flexion; a right paramedian frontal skin incision was made and a The patient’s family consent was obtained for publication. burr hole was performed at Kocher’s point to allow for an optimal trajectory. The cyst wall was reached with the aid of an introducer. The most superficial and lateral portion of the cyst capsule was coagu- lated and cut. The right choroid plexus and septal vein became Disclosure evident. Once inside the cyst, the relevant anatomy, stretched by The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. the giant cyst, could be recognized, including, posteriorly, the 706 | VOLUME 14 | NUMBER 6 | JUNE 2018 www.operativeneurosurgery-online.com Downloaded from https://academic.oup.com/ons/article-abstract/14/6/706/4562671 by Ed 'DeepDyve' Gillespie user on 21 June 2018
Operative Neurosurgery – Oxford University Press
Published: Oct 24, 2017
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