title: Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres.
abstract: OBJECTIVE
  Middle fossa arachnoid cysts (MFAC) are a relatively common, benign pathology that pose a therapeutic challenge for both symptomatic and asymptomatic patients. The optimal surgical strategy and indication to treat are still debated by neurosurgeons. We reviewed our experience and results in a group of patients treated with endoscopic fenestration with the aim to assess indications to treat and clinical and neuroradiological results.
  
  
  METHODS
  The data on 40 patients operated with endoscopic fenestration for MFAC in two centres, "Anna Meyer" Children's Hospital, Florence, Italy, and Royal Liverpool Children's Hospital "Alder Hey", Liverpool, UK, between 2001 and 2007 were retrospectively reviewed with prospective follow-up. We analysed clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and clinical and neuroradiological follow-up.
  
  
  RESULTS
  There were 30 males and ten females: mean age, 7.8 years; mean follow-up, 21 months. The neuronavigation system was used in 12 patients in the English cohort. Thirty-seven patients (92.5%) had a satisfactory clinical outcome. The cyst was reduced in size or completely disappeared in 29 patients (72.5%). There was no death or significant morbidity associated with the procedure. Four patients required further surgical treatment. Four patients experienced a post-traumatic intracystic bleeding after surgery.
  
  
  CONCLUSIONS
  Compared to microsurgical fenestration and cyst shunting, our experience with endoscopic fenestration was as effective and safe but less invasive. Each case must be assessed with its individual characteristics to define the optimal surgical strategy. Successful treatment may not reduce the risk of post-traumatic head injury haemorrhage.
authors.affiliation: Department of Pediatric Neurosurgery, Anna Meyer Children's Hospital, Florence, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Spacca
authors.forename: Jothy
authors.initials: J
authors.lastname: Kandasamy
authors.forename: Conor L
authors.initials: CL
authors.lastname: Mallucci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Genitori
mesh_terms: D000293:Adolescent; D000328:Adult; D016080:Arachnoid Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D019106:Postoperative Hemorrhage; D011859:Radiography; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult