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Suprasellar arachnoid cysts: Options in operative management

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Summary

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Beilinson Medical Center, University of Tel Aviv, Petah Tikva, Israel

    Z. H. Rappaport

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  1. Z. H. Rappaport
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Rappaport, Z.H. Suprasellar arachnoid cysts: Options in operative management. Acta neurochir 122, 71–75 (1993). https://doi.org/10.1007/BF01446989

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