Neuro-endoscopic approach in a case of intraventricular arachnoid cyst

Intraventricular arachnoid cysts are major neurosurgical lesions and their treatment is not without risk given the distance from the cerebral cortex. Endoscopy may be as effective as microsurgery with the advantage of being a minimally invasive procedure. We describe a 26-year-old man with a history of head injury presenting paroxysmal headache and gait disturbances. Bran MR scan disclosed triventricular hydrocephalus and a hypointense cystic lesion in the dilated left lateral ventricle. The patient underwent a neuro-endoscopic procedure with cyst fenestration, partial resection of the cyst wall with extensive communication with the ventricular system and a recovery of normal CSF circulation CT follow-up on the third day after surgery showed a reduction in cyst size. Follow-up at three and nine months after the procedure confirmed the stable clinical and MR findings. Different surgical treatments are possible for intraventricular cysts, but the treatment of choice is the minimally invasive endoscopic approach with fenestration of the cystic walt, especially in deep cysts such as those proximal to the ventricles or intraventricular lesions, with recovery of normal CSF circulation.