PMC5820883_01
Sagittal and axial magnetic resonance imaging T1-Weighted showed a dilated fourth ventricle due to an arachnoid cyst causing tri-ventricular hydrocephalus with trans-ependymal cerebrospinal fluid resorption
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F1
An urgent brain CT scan followed by MRI showed a dilated fourth ventricle due to an AC causing tri-ventricular hydrocephalus with trans-ependymal CSF resorption [Figure 1].
Sagittal and axial magnetic resonance imaging T1-Weighted showed a progressive reduction in size of the cyst and aqueduct as well as of the ventricular cavities
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F2
Brain MRI checks at 2, 6, and 12 months showed a progressive reduction in the size of the cyst and aqueduct as well as of the ventricular cavities [Figure 2].
Linear (1.5 cm) right frontal incision placed anteriorly on a frontal wrinkle or along the hairline
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F3
The operative approach consists of a linear (1.5 cm) right frontal incision placed rather anteriorly, possibly along the hairline [Figure 3], to easily direct the endoscope toward the posterior portion of the third ventricle and aqueduct.
Endoscopic photos showing cyst fenestration/marsupialization and third ventriculostomy
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F4
The cyst is identified and after visual inspection, a careful coagulation of its surface is performed aiming for as large a fenestration as possible, completed by forceps [Figure 4].