A Case Report: Endoscopic Surgical Treatment of Cerebral Arachnoid Cyst and Hydrocephalus In A Pediatric Patient

Abstract

An arachnoid cyst is a fluid-filled sac that can develop in either the spinal cord or the brain. The exact cause of its origin is not fully clarified; However, it is believed to be congenital, resulting from the abnormal development of arachnoid tissue. In most cases, it does not cause symptoms, although headache, convulsions, hydrocephalus, nausea, vomiting, and dizziness may be expressed. Symptoms vary depending on the location and size of the cyst. Untreated cysts can cause irreversible brain damage and movement problems. This clinical case involves a 1-year-old patient with a left cerebral arachnoid cyst and hydrocephalus. Based on clinical and radiological data, consultation with the head of the neurosurgical service was necessary, leading to a recommendation for surgical intervention, specifically cystoventriculocisternostomy as the initial stage. It should be noted that ventriculoperitoneal shunting is routinely used in the treatment of similar cysts; However, in this case, endoscopic surgical intervention was performed from the beginning, adding uniqueness to the treatment approach.

The patient was a 1-year-old boy with a history of a left-sided intracerebral enlarging arachnoid cyst and hydrocephalus. Neurological symptoms, dynamically progressive intracranial hypertension, cephalgia, nausea, vomiting, horizontal nystagmus, tense fontanelles and hydrocephalic head were presented. Based on these symptoms, neurosurgical intervention was necessary – cysto ventriculocisternostomy was performed, involving the fenestration of the cyst wall into the ventricular space. After the initial surgery, a follow-up CT scan revealed positive postoperative results. At this stage, the patient does not require additional surgical intervention. Outpatient neuroimaging control is recommended. In case of dynamic progression of hydrocephalus, further treatment strategies should be considered. 

Arachnoid cysts and accompanying hydrocephalus may cause neurological symptoms requiring urgent surgical intervention. Typically, surgical treatment of arachnoid cysts of the size and location present in our clinical case involves shunting. However, in this case, a cysto ventriculocisternostomy was performed to eliminate both the arachnoid cyst and the hydrocephalus. This method establishes a connection between the cyst and the ventricle to reduce intracranial pressure. After conducting neuroimaging studies of the brain, an improved picture of dynamics was revealed, emphasizing the importance of an individual approach in treatment, often leading to a better outcome.