PMC3784952_01
(a-c) The computed tomography scan of the brain showed a right fronto-parieto-temporal cystic lesion measuring 7 x 5 x 5 cm with a midline shift of 1 cm to the left suggestive of an arachnoid cyst
SNI-4-120-g001.jpg
PMC3784952_01_SNI-4-120-g001.jpg
F1
The computed tomography (CT) scan of the brain showed a large right fronto-parieto-temporal cystic lesion measuring 7 x 5 x 5 cm with a midline shift of 1 cm, suggestive of an arachnoid cyst [Figure 1a-c].
(a-d) An image guided endoscopic fenestration of the cyst. (a) The site of interest was identified using neuronavigation. (b) The intraoperative endoscopic image of forceps entering the parenchyma to fenestrate the cyst to the sylviann cistern. (c) Identification of sylviann cistern using neuronavigation and (d) Sylviann cistern
SNI-4-120-g002.jpg
PMC3784952_01_SNI-4-120-g002.jpg
F2
A neuronavigation-guided endoscopic fenestration of the cyst was done to communicate the arachnoid cyst with the ipsilateral sylvian cistern [Figure 2a-d].
(a and b) The diffusion tensor imaging with tractography of the brain showing the right fronto-parieto-temporal arachnoid cyst with major white matter projection and association pathways lying anteromedial to it
SNI-4-120-g003.jpg
PMC3784952_01_SNI-4-120-g003.jpg
F3
Fenestration of the cyst to directly communicate with the ipsilateral lateral ventricle was thought as an inappropriate choice because of the close proximity of the cyst wall with important ipsilateral white matter projection pathways and inferior occipito-frontal fasciculus or inferior longitudinal white matter tracts revealed by the 3 Tesla MR system with DTI and MR tractography (Gyroscan Intera, Philips Medical System, Eindhoven, Netherlands) [Figure 3a and b].
(a-c) The postoperative CT brain revealed a smaller arachnoid cyst without midline shift
SNI-4-120-g004.jpg
PMC3784952_01_SNI-4-120-g004.jpg
F4
Postoperatively, a repeated CT scan of the brain revealed a smaller arachnoid cyst with correction of the midline shift [Figure 4a-c].