Excision of juvenile pilocytic astrocytoma of the midbrain after radiotherapy

Indigenous customized sponge shunt for a recurrent brainstem cyst

BACKGROUND

Various treatment modalities are available for treatment of cystic lesions of the brainstem. However, cyst refilling and recurrences are very common. This article describes a young boy who presented with an intra-axial brainstem cyst following radiation for a pilocytic astrocytoma.

METHODS

The cyst was decompressed surgically once but it soon refilled. The use of a novel customized synthetic sponge acting as a shunt for the treatment of a cystic brainstem lesion is discussed. The sponge was fashioned like a dumbbell and inserted across the fenestration in the cyst wall.

RESULTS

The dumbbell design made it self-retaining. The characteristics of the sponge permitted continuous capillary drainage, with a low risk of occlusion. There was a dramatic decrease in the cyst size on follow-up scans, with resolution of clinical deficits.

CONCLUSIONS

A customized sponge shunt can serve as an easily available and effective internal shunt for intra-axial craniospinal cysts.