Cystoventriculo-peritoneal Shunt for a Giant Bifrontal Arachnoid Cyst : when Imaging Guides Surgery

Introduction The management of intracranial arachnoid cysts (IACs) represents a significant neurosurgical challenge due to the rarity and complexity of this pathology. Surgical intervention is reserved for symptomatic cases. We report the case of an adult patient with a giant bifrontal arachnoid cyst who was treated with a cystoventriculo-peritoneal (CVP) shunt. The selection of the surgical approach guided by neuroimaging was discussed. Case history A 51-year-old woman initially presented with progressive psychomotor impairment, gait disturbance, urinary incontinence, and seizures developing over several years. A neuronavigated CVP shunt with a programmable valve was performed to establish a pressure equilibrium between the cyst and the ventricular system while minimizing the risk of overdrainage. Conclusion Image-guided surgery that integrates high-resolution neuroimaging with cerebrospinal fluid (CSF) flow studies, represents a relatively novel approach in the management of intracranial arachnoid cysts (IACs). Although several surgical strategies have been described in the literature, the optimal treatment modality remains a matter of debate. A patient-specific approach based on detailed neuroimaging is crucial to optimize clinical outcomes while minimizing the risk of complications.