Thalamic neuroepithelial cysts: Endoscopic management strategies and clinical outcomes.

Abstract

e14046 Background: Thalamic neuroepithelial cysts are rare congenital lesions that can cause significant neurological morbidity through direct parenchymal compression or obstruction of cerebrospinal fluid pathways. Due to their rarity, optimal surgical management strategies remain poorly defined. This study presents our institutional experience with endoscopic fenestration for symptomatic thalamic cysts. Methods: . We conducted a retrospective review of patients with thalamic or parathalamic cysts treated at the Hospital of the University of Pennsylvania between 2014 and 2024. Patient demographics, clinical presentations, imaging characteristics, surgical approaches, and outcomes were analyzed. Treatment strategies included observation, endoscopic fenestration with or without third ventriculostomy, stereotactic procedures, and open craniotomy. Results: Nine patients (mean age 47.88±13.02 years, 77.8% female) were identified. Five patients with asymptomatic cysts underwent observation without intervention. Three symptomatic patients underwent endoscopic fenestration, two with concurrent third ventriculostomy for hydrocephalus. All fenestration procedures achieved technical success with complete symptom resolution and no recurrences. One patient with atypical imaging features underwent craniotomy, revealing cystic glioma. Mean hospital stay for endoscopic procedures was 1.5 days with no complications. Conclusions: Endoscopic fenestration is a safe and effective treatment for symptomatic thalamic neuroepithelial cysts. Surgical approach selection should be guided by cyst location relative to cerebrospinal fluid spaces, with frontal transcortical trajectories preferred for cysts abutting the third ventricle and lateral infratentorial approaches for posterior lesions. Asymptomatic cysts with benign imaging characteristics can be safely managed with surveillance imaging.