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TREATMENT OF POSTERIOR FOSSAE CYST THROUGH PRECORONAL ENDOSCOPIC APPROACH ALONE- CASE REPORT

Abstract
Background:
Posterior fossa cysts are usually treated by combined microsurgical and endoscopic approaches through a posterior fossa approach.

Patients and methods: We present a case of a woman, aged 79, who had remanent posterior fossa cysts after 8 years of removal of cerebellopontine neurinoma through classical suboccipital approach. She had complete removal of the lesion at the time.

In 2004 she began with instability, she had MNR which showed a big cyst compressing the 4thventricle with incipient hydrocephalus. She was operated on, using the previous approach, which made the surgery difficult because of scarring and damage of the left vertebral artery during dissection. The cyst wall was opened. Althouh there was clinical improvement a new MRI showed no changes in cyst image. Because of difficulties in last surgery, a cystoperitoneal catheter was introduced by stereotaxy. She did not improve this time, with an evolution towards achinetic mutism. The patient then underwent a successful endoscopic cyst fenestration through precoronal entrance. The endoscopic fenestration of the cyst wall was done after reaching the fourth ventricle through the sylvian acqueductus. The cyst was communicated to the fourth ventricle.

Results
The patient was alert the next day and well connected to people and surroundings, without neurological signs related to surgery. In control MRI the fourth ventricle had recovered its position and there was no hydrocephalus.
She died in 2006 of disease not related to her cerebellar pathology. There had been neither clinical nor radiological relapse up to the time of death. The clinical presentation, etiopathogenesis, imaging characteristics and treatment modalities are discussed and the relevant literature reviewed.

Conclusion: This report emphazises the possibility of approaching posterior fossa pathology successfully through endoscopic neurosurgery alone, using precoronal approaches as an alternative to traditional posterior approaches.

KEY WORDS: neuroendoscopy, posterior fossa cysts, cyst fenestration, precoronal approach.

REFERENCES

Cappabianca P, Buonamassa S, Cavallo LM, Mariniello G, de Divitiis O. Neuroendoscopy: present and future applications. Clin Neurosurg 51: 186-190, 2004.

P. Cappabianca, L.M. Cavallo, F. Esposito, E. de Divitiis, M. Tschabitscher. Endoscopic examination of the cerebellar pontine angle. Clin Neurol Neurosurg 104: 387-391, 2002.

Cinalli G, Cappabianca P, de Falco R, Spennato P, Cianciulli E, Cavallo LM, Esposito F, Ruggiero C, Maggi G, de Divitiis E. Current state and future development of intracranial neuroendoscopic surgery. Expert Rev Med Devices. 2:351-373, 2005.

M. Gangemi, F. Maiuri, G. Colella, L. Sardo. Endoscopic Surgery for Large Posterior Fossa Arachnoid Cysts. Minim Invasive Neurosurg 2001; 44: 21-24

Hopf, Nikolai J. MD; Perneczky, Axel PhD- Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts. Neurosurgery. 43(6):1330-1336, December 1998.

O. Mateo-Sierra; F.A. Gutiérrez; C. Fernández-Carballal; D. Pinilla; B. Mosqueira; B. Iza y R. Carrillo. Mutismo acinético relacionado con hidrocefalia y cirugía cerebelosa tratado con bromocriptina y efedrina. Revisión fisiopatológica- Neurocirugía vol.16 no.2 Murcia Apr. 2005

Schroeder, Henry W. S. M.D.; Gaab, Michael R. M.D., Ph.D. Endoscopic Aqueductoplasty: Technique and Results. Technique And Application
Neurosurgery. 45(3):508, September 1999

Souweidane, Mark M. M.D. Endoscopic Surgery for Intraventricular Brain Tumors in Patients without Hydrocephalus. Technique Assessments
Neurosurgery. 57(4) Operative Neurosurgery Supplement 4:312-318, October 2005.

Teo, Charles. Endoscopy Allows a Keyhole Approach to Many Skull Base Tumors. Neurosurgery. 43(3):713, September 1998.


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