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Endoscopic management of pineal cyst-associated aqueductal stenosis

  • Original Article - CSF Circulation
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Abstract

Object

The purpose of this study was to evaluate whether endoscopic third ventriculostomy (ETV) and endoscopic cyst fenestration are effective minimally invasive alternatives to a craniotomy with cyst resection for the treatment of symptomatic pineal cyst-associated aqueductal stenosis.

Methods

Sixteen patients with symptomatic pineal cysts were operatively managed endoscopically and these cases were retrospectively reviewed. There were 12 females and 4 males. The median age at the time of surgery was 31 years (range 3 to 62 years).

Results

All patients presented with symptoms and imaging consistent with elevated intracranial pressure. The median maximum cyst diameter was 15 mm (range 10 mm to 27 mm). In all cases, there was mass effect on the tectum that resulted in effacement of the cerebral aqueduct and ventriculomegaly was present in 38% of cases. ETV was performed in 15 patients. Cyst fenestration was performed in 2 patients, one of which also had an ETV. Resolution of symptoms was achieved in 81% of patients with a median follow-up of 13 months.

Conclusion

This study showed that ETV is effective for symptomatic pineal cyst-associated aqueductal stenosis. Patients can be symptomatic without overt ventriculomegaly and normal ventricular volume does not preclude safe endoscopic management. Endoscopic cyst fenestration is recommended if a Perinaud syndrome is present or if ETV is not feasible.

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Authors and Affiliations

  1. Division of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA

    Laurence Davidson

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  1. Laurence Davidson
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Correspondence to Laurence Davidson.

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The author declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Department of Research Programs Walter Reed National Military Medical Center Institutional Review Board) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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This article is part of the Topical Collection on CSF Circulation

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Davidson, L. Endoscopic management of pineal cyst-associated aqueductal stenosis. Acta Neurochir 162, 2975–2982 (2020). https://doi.org/10.1007/s00701-020-04419-1

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  • DOI: https://doi.org/10.1007/s00701-020-04419-1

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