Different approaches to surgical treatment of arachnoid cysts.

Although most arachnoid cysts remain static fluid-filled compartments throughout life, some become enlarged, exerting a mass effect on adjacent neural structures. The decision-making process for patients with arachnoid cysts still represents a challenge for the neurosurgeon. We report three cases of intracranial arachnoid cysts treated with different surgical approaches: (i) endoscopic fenestration of the cyst into the lateral ventricle; (ii) a cystoperitoneal shunt; (iii) a cystoperitoneal shunt and establishment of communication between the cyst and the fourth ventricle with the help of an endoscope. Given the advances in instrumentation over the past decade, it is probable that most arachnoid cysts will be managed endoscopically in the future.