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Coexistent intraventricular abnormalities in periventricular giant arachnoid cysts.
[hydrocephalus with stenosis of the aqueduct of sylvius]
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
.
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
.
The
endoscopic
findings
were
obstruction
of
the
cerebral
aqueduct
by
a
membrane
not
related
to
the
cyst
in
5
patients
,
occlusion
of
the
foramen
of
Monro
in
6
,
septum
pellucidum
hypoplasia
in
2
,
and
occlusion
of
the
cerebral
aqueduct
by
a
quadrigeminal
arachnoid
cyst
in
1
.
Endoscopic
procedures
performed
were
septum
pellucidum
fenestration
and
/
or
foraminoplasty
in
5
patients
,
aqueductoplasty
in
2
,
endoscopic
third
ventriculostomy
in
5
,
fenestration
of
the
lamina
terminalis
in
1
,
and
direct
cystocisternostomy
in
1
.
After
the
endoscopic
procedure
,
signs
and
symptoms
of
increased
intracranial
pressure
and
hydrocephalus
improved
in
all
patients
,
with
a
reduction
in
size
of
the
cyst
and
the
ventricle
.
Ventricular
abnormalities
contributing
to
hydrocephalus
may
be
associated
with
arachnoid
cysts
.
These
abnormalities
may
more
likely
reflect
a
common
origin
than
a
casual
relation
.
Foramen
of
Monro
stenosis
and
cerebral
aqueduct
occlusion
associated
with
an
arachnoid
cyst
can
be
more
frequent
than
has
been
previously
believed
.
In
cases
of
periventricular
giant
arachnoid
cysts
,
endoscopic
exploration
is
a
good
alternative
for
examining
the
ventricular
system
and
identifying
and
treating
CSF
obstructions
caused
by
and
/
or
related
to
arachnoid
cysts
.
Diseases
Validation
Diseases presenting
"cyst fenestration was then performed in all patients"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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