title: Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts.
abstract: OBJECTIVE
  The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts.
  
  
  METHODS
  The authors performed a retrospective review of 79 consecutive patients (1993-2010) with surgically treated intracranial arachnoid cysts.
  
  
  RESULTS
  The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years.
  
  
  CONCLUSIONS
  Posterior fossa cyst-ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA. dfulkers@iupui.edu
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Fulkerson
authors.forename: Todd D
authors.initials: TD
authors.lastname: Vogel
authors.forename: Abdul A
authors.initials: AA
authors.lastname: Baker
authors.forename: Neal B
authors.initials: NB
authors.lastname: Patel
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Ackerman
authors.forename: Jodi L
authors.initials: JL
authors.lastname: Smith
authors.forename: Joel C
authors.initials: JC
authors.lastname: Boaz
mesh_terms: D000293:Adolescent; D016080:Arachnoid Cysts / Q000175:diagnosis / Q000601:surgery*; D002408:Catheters, Indwelling; D002552:Cerebral Ventricles / Q000601:surgery*; D002648:Child; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003399:Craniotomy; D004867:Equipment Design; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D015607:Stents; D013238:Stereotaxic Techniques