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Peer-reviewedCC BY-NC-NDNeurologia Medico-Chirurgica

Flexible Endoscopic Transaqueductal Fenestration of Fourth Ventricular Arachnoid Cysts Combined with Endoscopic Third Ventriculostomy: A Technical Note

  • Takayuki ISHIKAWA1
  • Yuichi NAGATA1
  • Yugo KISHIDA1
  • Tetsuya NAGATANI1
  1. 1Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital
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Abstract

Fourth ventricular arachnoid cysts are rare and optimal surgical management remains unclear. We describe a flexible endoscopic trans-third ventricular technique for the treatment of fourth ventricular arachnoid cysts associated with obstructive hydrocephalus. Through a frontal approach, a flexible neuroendoscope is advanced via the foramen of Monro and third ventricle into the dilated cerebral aqueduct, allowing access to the fourth ventricle. Cyst fenestration is performed using biopsy forceps and a balloon catheter, and communication with surrounding cerebrospinal fluid spaces can be established. Endoscopic third ventriculostomy is performed concomitantly to ensure cerebrospinal fluid diversion. In selected cases, additional caudal fenestration toward the cisterna magna can be achieved to enhance cerebrospinal fluid circulation. This minimally invasive technique avoids posterior fossa craniotomy and enables simultaneous treatment of hydrocephalus. The approach is particularly suitable for cases with sufficient aqueductal dilation and offers a safe and effective alternative in selected patients.

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Cite

BibTeXRIS
BibTeX
@article{ishikawa2026flexible,
  title = {{Flexible Endoscopic Transaqueductal Fenestration of Fourth Ventricular Arachnoid Cysts Combined with Endoscopic Third Ventriculostomy: A Technical Note}},
  author = {Takayuki ISHIKAWA and Yuichi NAGATA and Yugo KISHIDA and Tetsuya NAGATANI},
  journal = {Neurologia Medico-Chirurgica},
  year = {2026},
  month = oct,
  doi = {10.2176/jns-nmc.2026-0176},
  url = {https://doi.org/10.2176/jns-nmc.2026-0176},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Flexible Endoscopic Transaqueductal Fenestration of Fourth Ventricular Arachnoid Cysts Combined with Endoscopic Third Ventriculostomy: A Technical Note
AU  - Takayuki ISHIKAWA
AU  - Yuichi NAGATA
AU  - Yugo KISHIDA
AU  - Tetsuya NAGATANI
PY  - 2026
DA  - 2026/10/01
JO  - Neurologia Medico-Chirurgica
DO  - 10.2176/jns-nmc.2026-0176
UR  - https://doi.org/10.2176/jns-nmc.2026-0176
AB  - Fourth ventricular arachnoid cysts are rare and optimal surgical management remains unclear. We describe a flexible endoscopic trans-third ventricular technique for the treatment of fourth ventricular arachnoid cysts associated with obstructive hydrocephalus. Through a frontal approach, a flexible neuroendoscope is advanced via the foramen of Monro and third ventricle into the dilated cerebral aqueduct, allowing access to the fourth ventricle. Cyst fenestration is performed using biopsy forceps and a balloon catheter, and communication with surrounding cerebrospinal fluid spaces can be established. Endoscopic third ventriculostomy is performed concomitantly to ensure cerebrospinal fluid diversion. In selected cases, additional caudal fenestration toward the cisterna magna can be achieved to enhance cerebrospinal fluid circulation. This minimally invasive technique avoids posterior fossa craniotomy and enables simultaneous treatment of hydrocephalus. The approach is particularly suitable for cases with sufficient aqueductal dilation and offers a safe and effective alternative in selected patients.
SN  - 1349-8029
SN  - 0470-8105
ER  -