title: Neuroendoscopic treatment for hydrocephalus associated to midline arachnoid cysts in a series of nine pediatric patients.
abstract: BACKGROUND
  Arachnoid cysts are extra-axial cerebrospinal fluid (CSF) collections surrounded by a membrane. Occasionally, hydrocephalus is associated due to a change in CSF circulatory dynamics. Neuroendoscopic treatment has been recommended for patients who develop symptoms resulting from the cyst location.
  
  
  METHODS
  We retrospectively evaluate the results in our series of 9 patients with hydrocephalus associated to midline arachnoid cysts treated endoscopically. Success was rated on a scale of five degrees of neuroendoscopical success.
  
  
  RESULTS
  We performed endoscopic third ventriculostomy (ETV) in three cases; ETV was associated to ventriculocystostomy (VC) in three cases; ETV, VC and septostomy (SPT) were performed in one patient; neuroendoscopic Monro foraminoplasty (NEFPMO) plus SPT were associated in one case; last patient was performed ETV, VC and cystocysternostomy (CC). For first procedures, 6 patients completed permanent Success (grade I). In one case success was transitory (grade II) and required a second procedure (ETV). In one patient VC success and ETV failure implied partial success (grade III). One patient's early failure (grade V) required a second procedure (ETV + NEFPMO). Success in second procedures was grade I in both patients. Follow-up period was over 12 months and altogether success was grade I in 8/9 patients and grade III in 1/9 patients. Shunt independency went over 88%.
  
  
  CONCLUSIONS
  Endoscopy allows a solution avoiding the implantation of cerebrospinal fluid shunt devices. When possible, we likely approach both, hydrocephalus and arachnoid cyst, with different endoscopic maneuvers in a single procedure. It is important to expand the usage of success classifications for combined procedures.
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Málaga, Spain - gonzalezgarcialaura@hotmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: González García
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Málaga, Spain.
authors.forename: Bienvenido
authors.initials: B
authors.lastname: Ros-López
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Málaga, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ibáñez-Botella
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Málaga, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Romero Moreno
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Málaga, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Martin Gallegos
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Málaga, Spain.
authors.forename: Miguel Á
authors.initials: MÁ
authors.lastname: Arráez-Sánchez
mesh_terms: D016080:Arachnoid Cysts / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007223:Infant; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*