title: Endoscopic treatment of arachnoid cysts: a detailed account of surgical techniques and results.
abstract: BACKGROUND
  Surgical treatment of arachnoid cysts remains under debate. Although many authors favor endoscopic techniques, others attribute a higher recurrence rate to the endoscope.
  
  
  OBJECTIVE
  The authors report their experience with endoscopic procedures for arachnoid cyst.
  
  
  METHODS
  All pure endoscopic procedures for arachnoid cysts performed by the authors were analyzed. Particular reference was given to surgical complications and patient outcome in relation to cyst location and endoscopic technique.
  
  
  RESULTS
  Sixty-six endoscopic procedures were performed in 61 patients (mean age, 28 years; range, 23 days to 74 years; 35 males, 26 females). The main presenting symptoms were cephalgia (61%), hemisymptoms (18%), and macrocephalus (18%). Cyst location was temporobasal (34%), suprasellar (21%), at the cisterna quadrigemina (18%), paraxial supratentorial (16%), and various (10%). Thirty cystocisternostomies, 14 ventriculocystostomies, 12 cystoventriculostomies, and 10 ventriculocystocisternostomies were performed. The overall clinical success rate was 90%. The endoscopic technique was abandoned in 4 cases (7%). Postoperative complications were found in 16%; there was only one permanent deficit (2%). Five recurrences (8%) occurred up to 7 years after the first procedure. Of the various locations, the temporobasal cysts were the most difficult to treat with lowest clinical success (81%), highest recurrence (19%), and highest complication rate (24%). Of the various endoscopic techniques, ventriculocystostomy and ventriculocystocisternostomy reached the highest success rates with 100%.
  
  
  CONCLUSIONS
  Endoscopic techniques provide very good results in arachnoid cyst treatment. The most frequent cyst location is the most difficult to treat. A long-term follow-up is recommended since recurrences can occur many years after the procedure.
authors.affiliation: Department of Neurosurgery, Johannes-Gutenberg-University, Mainz, Germany. oertelj@freenet.de
authors.forename: Joachim M K
authors.initials: JM
authors.lastname: Oertel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wagner
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Mondorf
authors.forename: Joerg
authors.initials: J
authors.lastname: Baldauf
authors.forename: Henry W S
authors.initials: HW
authors.lastname: Schroeder
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gaab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016080:Arachnoid Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D020547:Lateral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult