• Eriko Okumura, Kazuhito Takeuchi, Yuichi Nagata, Kenichiro Iwami, Kazuya Motomura, Fumiharu Ohka, Yoshiki Sato, Toshiaki Hirose, and Ryuta Saito.
• Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City 466-8550, Japan.
• World Neurosurg. 2024 Oct 17.

AbstractSurgical interventions for arachnoid cysts and glioependymal cysts primarily focus on cyst decompression and establishing communication with cerebrospinal fluid (CSF) spaces. However, a standardized surgical strategy for symptomatic convexity cysts lacking surrounding CSF space is still lacking due to the limited number of cases. This systematic review aims to evaluate surgical interventions for symptomatic convexity cysts and proposes a safe and effective treatment approach we have developed. A systematic review of the literature was conducted following PRISMA guidelines. Surgical techniques were categorized into cystoperitoneal (CP) shunt, cyst excision, cyst fenestration, cyst ventriculostomy, and several uniquely modified methods. Using a method different from these previous reports, we performed endoscopic cystoventricular stenting via burr hole in three cases of convexity cysts. While traditional methods have proven effective, CP shunt may lead to malfunction, infection, and subdural hematoma; wall excision is invasive and increases morbidity risks. Fenestration and cystoventriculostomy have also reported cases of recurrence. Other methods also pose issues, including off-label use of instruments and inadequate consideration for removal. The method we performed for placing the stent catheter with multiple side holes demonstrated long-term effectiveness. Furthermore, the surgery was conducted with the patient fully awake, and the use of electrical stimulation mapping enabled preservation of higher neurocognitive functions, including language, working memory, and spatial cognition, at the puncture site. This novel approach offers advantages such as minimally invasive procedure, preservation of safe brain function, and long-term patency. Further studies are warranted to validate these findings and improve surgical strategies for convexity cysts.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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