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Table of Contents    
Year : 2017  |  Volume : 65  |  Issue : 3  |  Page : 473-474

Role of neuro-endoscopy and fenestration in the management of brain cysts

Institute of Neurosciences, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal

Date of Web Publication9-May-2017

Correspondence Address:
Iype Cherian
Institute of Neurosciences, Nobel Medical College and Teaching Hospital, Biratnagar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/neuroindia.NI_319_17

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How to cite this article:
Cherian I. Role of neuro-endoscopy and fenestration in the management of brain cysts. Neurol India 2017;65:473-4

How to cite this URL:
Cherian I. Role of neuro-endoscopy and fenestration in the management of brain cysts. Neurol India [serial online] 2017 [cited 2021 Sep 27];65:473-4. Available from:

At the first look, this is an article where the impression is that the “odds are good, but the goods are odd.” However, as one delves into the article and also looks at the experiences of other authors in the field, as well refers to multiple references dealing with this subject, it is apparent that the author has performed a satisfactory job in convincing the neurosurgical community that a 'war cry and cannon fire' (translated as a large craniotomy and a large corridor of approach) is not exactly what one needs within the operation theatre when one is dealing with intracranial cysts.

Neuro-endoscopy has evolved in the recent years to become a valuable armamentarium in the neurosurgical arena thanks largely to an improved lens quality, camera flexibility and the development of refined methods to deal with various lesions.[1] The major advantages of the procedure are its minimalism causing less trauma to the surrounding healthy brain, a better resolution of the operative field with panoramic view, and an improved degree of freedom, when compared with the open microsurgical techniques.[2]

There are some inherent constraints to its usage such as a steep learning curve and the need to re-learn the topographic anatomy of the brain based on the endoscopic view, prior to its use intra-operatively. The simultaneous use of neuro-navigation helps to exactly localize the trajectory of the endoscope relative to the adjoining anatomy.[1],[3]

With regard to the cystic lesions in the brain, most of the asymptomatic ones are managed conservatively. However, in the presence of mass effect, neurological deficits and associated hydrocephalus, there is the need to manage them either via a microsurgical approach or via the use of an endoscope. Studies have justified the role of 'only fenestration' in the management of such lesions especially when they are intra-ventricular in location.[4] In sharp contrast to the floor of these intraventricular cysts, which are lined by epithelial, ependymal or glial lining, their roof is only lined by an epithelial membrane, thereby facilitating fenestration. Some authors do consider these lesions as being equivalent to arachnoid cysts, having their origin from the choroid plexus.[5] Attempts at complete excision increase the odds of developing hemorrhage and also subsequent fibrosis, thereby leading to an increased risk of hydrocephalus in the later days.

The study by Bir et al., has tried to justify the usage of an endoscope in the management of the cystic lesions in the brain.[6] The endoscopic procedure was found to be more effective in the management of arachnoid cysts, especially in the adults and also among female patients, and those having obstructive hydrocephalus. There was better resolution of the symptoms with minimal recurrence in the size of the cysts during the patient's follow up. However, there are certain limitations inherent within the study, the foremost being that it is a single center study with a small cohort group, and a limited period of follow up.

This study has paved the pathway to emphasize the role of neuro-endoscopy and fenestration in the management of the brain cysts. However, more multi-centric randomized control trials with a long-term follow up are advocated to universally and unequivocally establish the role of an endoscope in the management of intracranial cysts.

  References Top

Shou X, Zhao Y, Li S, Wang Y. Ventriculoscopic surgery for arachnoid cysts in the lateral ventricle: A comparative study of 21 consecutive cases. Int J Clin Exp Med 2015;8:20787-95.  Back to cited text no. 1
Oertel JM, Wagner W, Mondorf Y, Baldauf J. Endoscopic treatment of arachnoid cyst: A detailed account of surgical techniques and results. Neurosurgery. 2010;67:824-36.  Back to cited text no. 2
Schroeder HW, Wagner W, Tschiltschke W, Gaab MR. Frameless neuronavigation in intracranial endoscopic neurosurgery. J Neurosurg 2001;94:72-9.  Back to cited text no. 3
Kim MH. The role of endoscopic fenestration procedures for cerebral arachnoid cysts. J Korean Med Sci 1999;14:443-7.  Back to cited text no. 4
Pelletier J, Milandre L, Peragut JC, Cronqvist S. Intraventricular choroid plexus “arachnoid” cyst. MRI findings. Neuroradiology 1990;32:523-5.  Back to cited text no. 5
Bir SC, Konar SK, Maiti TK, Kalakoti P, Bollam P, Guthikonda B, Nanda A. Do the clinicoradiological outcomes of endoscopic fenestration for intracranial cysts count on age? An institutional experience. Neurol India 2017;65:539-45.  Back to cited text no. 6
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