Suprasellar arachnoid cysts: Options in operative management
- 78 Downloads
Suprasellar arachnoid cysts are uncommon lesions the optimal management of which is still subject for debate. Various authors have presented differing treatment preferences which include: 1) Subfrontal fenestration of the cyst to the basal cisterns; 2) Transcallosal fenestration of the cyst into the lateral ventricles with optional shunting; 3) Cystoperitoneal shunt; 4) Percutaneous ventriculocystostomy. There is a significant incidence of re-operation whatever the initial approach.
Based on recent experience with 5 operative cases of suprasellar arachnoid cyst and a selective review of 6 major operative series covering 42 cases, the available surgical options are critically analyzed. Percutaneous ventriculostomy may offer the best chance for a definitive treatment. However the technique is demanding and is not readily available. Cystoperitoneal shunting entails shunt dependency and has a significant incidence of failure, as does cyst marsupialization to the subarachnoid cisterns. The establishment of a single CSF space by surgically communicating the cyst with the ventricular system appears to offer the best chance of success in the treatment of suprasellar arachnoid cysts, though a concomittant shunt may still be required in the occasional hydrocephalic patient.
KeywordsSuprasellar arachnoid cysts surgical therapy
Unable to display preview. Download preview PDF.
- 1.Albright L (1981) Treatment of bobble-head doll syndrome by transcallosal cystectomy. Neurosurgery 8: 593–595Google Scholar
- 2.Benton JW, Nellhaus G, Huttenlocher PR,et al (1966) The bobble-head doll syndrome. Report of unique truncal tremor associated with third ventricular cyst and hydrocephalus in children. Neurology 16: 725–729Google Scholar
- 3.Binitie O, Williams B, Case CP (1984) A suprasellar arachnoid pouch; aetiological considerations. J Neurol Neurosurg Psychiatry 47: 1066–1074Google Scholar
- 4.Fox JL, Al-Mefty O (1980) Suprasellar arachnoid cyst: an extension of the membrane of Lilliequist. Neurosurgery 7: 615–618Google Scholar
- 5.Gentry CR, Menezes AH, Turksi PA, Smoker WRK, Cornell SH, Ramirez L (1986) Suprasellar arachnoid cyst. Part 2: evaluation of CSF dynamics. AJNR 7: 86–96Google Scholar
- 6.Giroud M, Sautreux JL, Thierry A, Dumas R (1988) Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant. Childs Nerv Syst 4: 252–254Google Scholar
- 7.Go KG, Houthoff HJ, Blaouw EH,et al (1984) Arachnoid cyst of the Sylvian fissure. Evidence of fluid secretion. J Neurosurg 60: 803–810Google Scholar
- 8.Harsh GR, IV, Edwards MSB, Wilson CB (1986) Intracranial arachnoid cysts in children. J Neurosurg 64: 835–842Google Scholar
- 9.Hoffmann HJ, Hendrick EB, Humphreys RP, Armstrong EA (1982) Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57: 597–602Google Scholar
- 10.Jones RF, Warnock TH, Nayanar V, Gupta JM (1989) Suprasellar arachnoid cysts: management by cyst wall resection. Neurosurgery 25: 554–561Google Scholar
- 11.Kasdon DL, Douglas EA, Brougham ME (1977) Suprasellar arachnoid cyst diagnosed preoperatively by computerized tomographic scanning. Surg Neurol 7: 299–303Google Scholar
- 12.Krawchenko J, Collins GH (1979) Pathology of an arachnoid cyst. J Neurosurg 50: 224–228Google Scholar
- 13.Murali R, Epstein F (1979) Diagnosis and treatment of suprasellar arachnoid cyst: report of three cases. J Neurosurg 50: 515–515Google Scholar
- 14.Palma L, Celli P (1983) Suprasellar epithelial cyst. J Neurosurg 58: 763–765Google Scholar
- 15.Pierre-Kahn A, Capelle L, Brauner R, Sainte-Rose C, Renier D, Rappaport R, Hirsch JF (1990) Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg 73: 355–359Google Scholar
- 16.Raffel C, McComb JG (1988) To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients. Neurosurgery 23: 338–342Google Scholar
- 17.Raimondi AJ, Shimoji T, Guitierrez FA (1980) Suprasellar cysts: surgical treatment and results. Childs Brain 7: 57–72Google Scholar
- 18.Rengachary SS, Watanabe I, Brackett CE (1978) Pathogenesis of intracranial arachnoid cysts. Surg Neurol 9: 139–144Google Scholar