Neurosurgery and Neuroscience

Background: Posterior fossa cysts are benign but usually developmental lesions. There are patient usually asymptomatic. Some cysts might communicate with these subarachnoid spaces however non-communicating cyst could develop from communicating ones giving rise to complexity of diagnosis and further management.

 

Case Description: One year old baby girl presented with developmental delay which is gross motor and speech with increase ICP symptoms. CT brain and MRI revealed large posterior fossa cyst extending supratentorially causing compression to the third ventricle and showing gross hydrocephalus. We proceed with endoscopic fenestration of posterior fossa cyst and ommaya insertion and subsequently proceeded with ventricular peritoneal shunt. Due to previous history of necrotizing enterocolitis (NEC), patient developed malfunction of the shunt due to poor absorption of the shunt, eventually patient required ventriculo-cysto-atrial shunt. 6 months post-procedure, patient currently does not show any evidence of recurrent cyst and developmentally showing improvement.

 

Conclusion: Posterior fossa cyst is rare and contributes to challenges radiologically and surgically. Current surgical management mainly depends more on clinical features giving little insights on the exact pathology of posterior fossa cyst.