• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.69-73
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• 2006

Objective : The optimal surgical treatment for symptomatic middle cranial fossa arachnoid cysts is controversial. Therapeutic options include endoscopic fenestration, excision, cyst shunting, and craniotomy for fenestration of basal cistern. We reviewed the results of surgically treated middle cranial fossa arachnoid cysts. Methods : We performed a retrospective study in 18 cases of middle cranial fossa arachnoid cysts who had been treated with microsurgical fenestration between 1995 to 2003. The analysis was based on the results of the patients' age, sex distribution, developed area, clinical symptoms, treatment method, and complications. Results : Eighteen surgical treated middle cranial fossa arachnoid cysts patients were evaluated. The age range of cyst development was between 2 years and 44 years with the average of 16.4 years. The follow-up periods averaged 31.48 months. There were 15 male and 3 female patients, with significantly more cyst development in males than females. The most common clinical symptom was headache, followed by seizure. In the entire series, 77.8% of patients demonstrated a decrease in cyst size In serial imaging studies. Of them, 67.3% demonstrated a complete cyst effacement. Overall, 100% of patients with Grade I cysts, 81.8% of patients with Grade II cysts, 60% of patients with Grade III cysts exhibited evidence of decrease in cyst size during long-term monitoring. Complications included headache, meningitis, and hydrocephalus. Conclusion : Patients who were treated with microsurgical fenestration showed good outcome with acceptable complications. We concluded that microsurgical fenestration is a safe and effective surgical method for middle cranial fossa arachnoid cysts.

• Journal of Korean Neurosurgical Society
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• v.60 no.3
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• pp.301-305
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• 2017

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.