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Direct puncture for diagnosis of intradural spinal arachnoid cyst and fenestration using 3D rotational fluoroscopy: technical note and the “jellyfish sign”

Ziev B. Moses, John H. Chi, and Ram V. S. R. Chavali

thin flexible wire to pierce the cyst followed by balloon inflation parallels that used in endoscopic third ventriculostomy (ETV), in which a semi-blunt dissector is passed through the floor of the third ventricle followed by dilation with a 2- or 3-Fr balloon catheter. 5 It is important to deflate the balloon prior to returning the catheter into the cyst as otherwise it may tear the wall (or the floor of the third ventricle in the case of ETV) and result in bleeding. While in ETV bleeding can be monitored by direct visualization through the endoscope, during