Ventrikulozystostomie

Ventrikulozystostomie, or ventriculocystostomy, is a neurosurgical procedure that creates a communication between a cerebral ventricle and an adjacent cyst, most commonly an arachnoid cyst. The goal is to divert cerebrospinal fluid (CSF) from the cyst into the ventricular system or subarachnoid space, thereby reducing cyst size, relieving mass effect, and treating hydrocephalus when present.

Indications include symptomatic supratentorial arachnoid cysts, porencephalic cysts with CSF communication, and other intraparenchymal cysts associated with hydrocephalus or raised intracranial pressure, particularly when the cyst is well delineated from surrounding brain and accessible by endoscopic or microsurgical approach. Patient selection relies on imaging showing a viable communication pathway and absence of contraindicating anomalies. In some cases ventrikulozystostomie may be combined with other CSF diversion strategies.

Technique is typically performed through a burr hole. An endoscope or microscope is used to identify the ventricle and the cyst wall; a fenestration is created between the two compartments, allowing CSF to flow. The fenestration may be left open, enlarged gradually, or supported with a small stent or valve in selected cases. Endoscopic ventriculocystostomy is preferred for select cysts because it is minimally invasive and allows direct visualization; microsurgical fenestration is used when endoscopy is not feasible.

Outcomes vary with cyst type and hydrocephalus; successful cyst drainage may relieve symptoms and reduce ventricular size, but some patients require additional CSF diversion such as ventriculoperitoneal shunting. Complications include bleeding, infection, injury to neural structures, reclosure of the fenestration, seizures, and CSF leakage. Alternatives include cyst fenestration to the basal cisterns, cystoperitoneal shunting, ventriculoperitoneal shunting, or endoscopic third ventriculostomy in certain hydrocephalus cases. The procedure has evolved since its early descriptions and is now most commonly performed with neuroendoscopy.