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Neurology (Expert Forum)
arachnoid cysts and shunts
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
arachnoid cysts and shunts
by bloatedmom, Sep 26, 2009 09:54AM
I have a large arachnoid cyst in the posterior fossa with mass effect but no symptoms. Most neurosurgeons recommend they would fenestrate the cyst, but one neurosurgeon recommended also using a small shunt from the cyst to the top of the spinal cord (not into the peritoneum). I know the ventriculo-peritoneal shunts have a large infection and complication rate. What about these small shunts that are within the CSF space? Do they have a lot of complications or are they lower risk?
Thank you for your input.
Thank you for your input.
Doctor's Answer
by Lama Chahine, MD, Sep 29, 2009 08:03PM
, Sep 29, 2009 08:03PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history and review your imaging, I can not make specific treatment recommendations. However I will try to provide you with some useful information.
Arachnoid cysts are sacs filled with cerebropsinal fluid (CSF) which is the fluid that normally bathes the brain and spine. This fluid is normally located in the part of the brain called the subarachnoid space. If an arachnoid cyst is deemed to be causing symptoms or is pressing on surrounding structures (which would most often be evident on your MRI), surgical opening (fenestration) of the cyst and other surgical interventions could be done to correct it, but this is rarely necessary because the vast majority of arachnoid cysts are benign, do not grow, and do not cause symptoms or significant pressure on surrounding brain structures.
When surgery is necessary, fenestration is one option as you mention. Shunting is used in some cases as well. Each has its own advantages. Neurosurgery is beyond my area of expertise, so I can only provide you with limited information. Endoscopic fenestration is less invasive than procedures involving shunts, because a craniotomy (cutting and removal of the skull itself) is not necessary; with cysto-peritoneal shunts, or any shunting procedure that requires craniotomy, the surgery can be more invasive, has its own complications, including infections, but allows for more rapid reduction in the size of the arachnoid cyst than fenestration alone. In general, any foreign object placed in the body increases risk of infection; while I am not aware of the specific research in this area, I assume that a shunt within the central nervous system would carry less of an infection that shunt to the peritoneum.
Discussion with your neurosurgeon of the risks and benefits of the surgery, and the various surgical options is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck
Without the ability to examine you and obtain a history and review your imaging, I can not make specific treatment recommendations. However I will try to provide you with some useful information.
Arachnoid cysts are sacs filled with cerebropsinal fluid (CSF) which is the fluid that normally bathes the brain and spine. This fluid is normally located in the part of the brain called the subarachnoid space. If an arachnoid cyst is deemed to be causing symptoms or is pressing on surrounding structures (which would most often be evident on your MRI), surgical opening (fenestration) of the cyst and other surgical interventions could be done to correct it, but this is rarely necessary because the vast majority of arachnoid cysts are benign, do not grow, and do not cause symptoms or significant pressure on surrounding brain structures.
When surgery is necessary, fenestration is one option as you mention. Shunting is used in some cases as well. Each has its own advantages. Neurosurgery is beyond my area of expertise, so I can only provide you with limited information. Endoscopic fenestration is less invasive than procedures involving shunts, because a craniotomy (cutting and removal of the skull itself) is not necessary; with cysto-peritoneal shunts, or any shunting procedure that requires craniotomy, the surgery can be more invasive, has its own complications, including infections, but allows for more rapid reduction in the size of the arachnoid cyst than fenestration alone. In general, any foreign object placed in the body increases risk of infection; while I am not aware of the specific research in this area, I assume that a shunt within the central nervous system would carry less of an infection that shunt to the peritoneum.
Discussion with your neurosurgeon of the risks and benefits of the surgery, and the various surgical options is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck
