Symptomatic Choroidal Fissure Arachnoid Cyst: Treatment by Endoscopic Fenestration

Introduction:Choroidal fissure cysts are usually incidental findings on imaging studies. They are typically benign lesions, although in some cases they may cause morbidity due to intracranial hypertension. The formation of cysts in this location is related to abnormal development of the choroid tela and the choroidal fissure. Fewer than ten cases have been reported in the literature. Case description: A 3-month-old patient with a small choroidal fissure cyst at birth presented with acute symptoms of intracranial hypertension, nausea, and vomiting. Imaging revealed a rapid and severe enlargement of the arachnoid cyst within just two weeks, reaching a preoperative size of 50 × 35 × 30 mm. The patient underwent endoscopic fenestration of the cyst, resulting in complete resolution of clinical symptoms in the early postoperative period and marked reduction in cyst size on imaging (36 × 21 × 24 mm) one day after surgery.At two-month follow-up, the cyst measured 28 × 21 × 19 mm. Symptomatic choroidal fissure cysts are exceptionally rare, with only eight clinical cases reported to date in the literature. Traditionally, treatment has consisted of cystoperitoneal shunting. We currently believe that endoscopic treatment can be offered as a first-line option, achieving complete clinical resolution without evidence of complications. Conclusion:Symptomatic choroidal fissure cysts are an exceptionally rare pathology. Treatment by endoscopic fenestration provides excellent clinical and radiological resolution without additional short-term complications.