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Procedures and Outcomes
The two most common procedures performed on an Arachnoid Cyst are fenestration and shunting.
Depending on the size of the cyst, fenestration can either be done endoscopically or after a craniotomy.
Procedure details
Endoscopic Fenestration is done by making one or two dime sized holes in the skull. The surgeon then guides the endoscope into the brain until it reaches the arachnoid cyst. Then a small incision is made into the cyst to help the fluid flow out, so that the pressure is relieved.
Craniotomy Fenestration is done by removing a portion of the skull so the surgeon can access the brain. Then an incision is made into the arachnoid cyst during the fenestration, so that the cyst fluid can drain out.
Cysto-peritoneal shunting is the most common form of shunting performed on arachnoid cysts. In this procedure a shunt catheter is placed inside the arachnoid cyst and is attached to a distal tube which allows the cyst fluid to drain down to the abdomen. But in some cases Ventriculo-Perotineal and even Cysto-Pleural shunting are performed on arachnoid cyst patients. If the arachnoid cyst is in communication with the ventricles, the shunt can be placed in the ventricles and drained to either the abdomen, pleura, jugular vein or heart.
Outcomes
Endoscopic Fenestration
Endoscopic fenestration can achieve positive results, and is minimally invasive. After surgery the patient usually leaves the hospital after 24 hours, if not the same day.
Craniotomy Fenestration
Whenever the brain is open to the air, there is a risk of infection. When a bone flap is removed from the skull, it comes along with a significant amount of pain. But all going well the patient should leave the hospital two to four days after surgery. In some cases the bone flap is wired back onto the skull at a later date, but this sometimes is not necessary.
Shunting
If possible shunting should be a last resort because the patient can become shunt dependent or suffer shunt related complications in addition to the arachnoid cyst. This can result in multiple surgeries, which are called shunt revisions. There is also an increased risk for infection every time the shunt is revised. If the patient becomes infected, the shunt will need to be externalized while the patient is given antibiotics. The hospital stay for this is quite long and entails at least two surgeries.
Unfortunately, even if the surgery (whichever it may be) is successful, and symptoms dissipate, arachnoid cysts can reaccumulate. If the patient's first surgery was a craniotomy fenestration, the second surgery is usually placement of a shunt. Some have complete resolution with only one surgery, whereas others need three or four before the cyst stops causing symptoms. This is one of the reasons why Arachnoid Cyst Awareness is pleading with the medical world to introduce more research into this subject, so that a more solid cure can be found.
We urge everyone to take a look at the forums and links on this website because often times other members write about their surgery experiences and how they are doing as a result.
