Abstract
Objective
Arachnoid cysts constitute 1% of all intracranial mass lesions not resulting from trauma. Suprasellar arachnoid cysts (SACs) are uncommon. Obstructive hydrocephalus is the most common cause of initial symptoms and occurs in almost 90% of the patients with suprasellar arachnoid cyst. We report on 17 patients with suprasellar arachnoid cyst who were treated with neuroendoscopic intervention.
Materials and methods
Seventeen patients with SAC had been operated on between 1999 and 2007 in our institution. Five patients had previously undergone shunting procedures or craniotomy. Nine boys and eight girls ranged in age from 4 months to 17 years (mean 53.2 months). All patients had hydrocephalus. A wide ventriculocystostomy (VC) or a ventriculo-cysto-cisternostomy (VCC) was done by using rigid neuroendoscopes. Psychometric evaluation was administered postoperatively, when possible. Follow-up of the patients ranged from 6 months to 7 years (mean 41.6 months).
Results
Of the 17 patients, 12 underwent endoscopic procedure as the primary surgery. VC only was performed in the first patient. In the remaining 16 patients, VCC was done. A slit-valve mechanism was observed in 14 patients. Three patients needed a VP shunt, despite a successful VCC. Three of five patients, younger than 1 year of age became shunt dependent and none of the patients older than 1 year of age needed shunting. In four patients presented with shunt malfunction, the shunts were removed after endoscopic surgery. Only one subject’s total score was under the normal IQ limits but her subtests scores were heterogeneous. However, there was marked discrepancy among her subtests scores.
Conclusion
Endoscopic surgery should be the first choice in the management of SACs. Neuroendoscopic VCC is successful in the majority of the cases.
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References
Adan L, Bussieres L, Dinand V, Zerah M, Pierre-Kahn A, Brauner R (2000) Growth, puberty and hypothalamic–pituitary function in children with suprasellar arachnoid cyst. Eur J Pediatr 159:348–355
Buxton N, Vloeberghs M, Punt J (1999) Flexible neuroendoscopic treatment of suprasellar arachnoid cyst. Brit J Neurosurg 13:316–318
Caemert J, Abdullah J, Calliauw L, Carton D, Dhooge C, van Coster R (1992) Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 119:68–73
Charalampaki P, Filippi R, Welschehold S, Conrad J (2005) Endoscopic and endoscope-assisted neurosurgical treatment of suprasellar arachnoidal cysts (Mickey Mouse cysts). Minim Invasive Neurosurg 48:283–288
Choi JU, Kim DS (1998) Pathogenesis of arachnoid cyst: congenital or traumatic? Pediatr Neurosurg 29:260–266
Ciricillo SF, Cogen PH, Harsh GR, Edwards MSB (1991) Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting. J Neurosurg 74:230–235
Crimmins DW, Pierre-Kahn A, Sainte-Rose C, Zerah M (2006) Treatment of suprasellar cysts and patient outcome. J Neurosurg 105(2 Suppl):107–114
Decq P, Brugières P, Le Guerinel C, Djindjian M, Kéravel Y, Nguyen J-P (1996) Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696–701
Desai KI, Nadkarni TD, Muzumdar D, Goel A (2003) Suprasellar arachnoid cyst presenting with bobble-head doll movements: a report of 3 cases. Neurology India 51:407–409
Dhooge C, Goavaert P, Martens F, Caemert J (1992) Transventricular endoscopic investigation and treatment of suprasellar arachnoid cysts. Neuropediatrics 23:245–247
Dodd RL, Barnes PD, Huhn SL (2002) Spontaneous resolution of a prepontine arachnoid cyst. Case report and review of the literature. Pediatr Neurosurg 37:152–157
Fioravanti A, Godano U, Consales A, Mascari C, Calbucci F (2004) Bobble-head doll syndrome due to a suprasellar arachnoid cyst: endoscopic treatment in two cases. Childs Nerv Syst 20:770–773
Fitzpatrick MO, Barlow P (2001) Endoscopic treatment of prepontine arachnoid cysts. Br J Neurosurg 15:234–238
Fox JL, Al-Mefty O (1980) Suprasellar arachnoid cysts: an extension of the membrane of Liliequist. Neurosurgery 7:615–618
Hagebeuk EEO, Kloet A, Grotenhuýs JA, Peeters EAJ (2005) Bobble-head doll syndrome successfully treated with an endoscopic ventriculocystocisternostomy. Case report and review of the literature. J Neurosurg 103(3 Suppl):253–259
Jones RF, Warnock TH, Nayanar V, Gupta JM (1989) Suprasellar arachnoid cysts: management by cyst wall resection. Neurosurgery 25:554–561
Kirollos RW, Javadpour M, May P, Mallucci C (2001) Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718
Marcoux J, Roy D, Bojanowski MW (2002) Acquired arachnoid cyst after a coil-ruptured aneurysm. Case illustration. J Neurosurg 97:722
Martinez-Lage JF, Poza M, López F (1991) Arachnoid cyst as a complication of ventricular shunting. Childs Nerv Syst 7:356–357
Miyajima M, Arai H, Okuda O, Hishii M, Nakanishi H, Sato K (2000) Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases. J Neurosurg 93:62–67
Mohn A, Fahlbusch R, Dörr HG (1999) Panhypopituitarism associated with diabetes insipidus in a girl with a suprasellar arachnoid cyst. Hum Res 52:35–38
Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8:281–286
Pell MF, Thomas DG (1991) The management of infratentorial arachnoid cyst by CT directed stereotactic aspiration. Br J Neurosurg 5:399–403
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 73:355–359
Pierre-Kahn A, Hanlo P, Sonigo P, Parisot D, McConnell RS (2000) The contribution of prenatal diagnosis to the understanding of malformative intracranial cysts: state of the art. Childs Nerv Syst 16:618–626
Rappaport ZH (1993) Suprasellar arachnoid cysts: options in the operative management. Acta Neurochir (Wien) 122:71–75
Santamarta D, Aguas J, Ferrer E (1995) The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 38:133–137
Savasir I, Sezgin N, Erol N (1998) Ankara Developmental Screening Inventory Manual. Psikologlar Derneði, 2. Ankara
Schroeder HWS, Gaab MR, Niendorf WR (1996) Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85:293–298
Sood S, Schuhmann MU, Cakan N, Ham SD (2005) Endoscopic fenestration and coagulation shrinkage of suprasellar arachnoid cysts: technical note. J Neurosurg 102(1):127–133
Struck AF, Murphy MJ, Iskandar BJ (2006) Spontaneous development of a de novo suprasellar arachnoid cyst. Case report. J Neurosurg 104(6 Suppl):426–428
Sweasey TA, Venes JL, Hood TW, Randall JB (1989) Stereotactic decompression of a prepontine arachnoid cyst with resolution of precocious puberty. Pediatr Neurosci 15:44–47
Thompson TP, Lunsford LD, Kondziolka D (2000) Successful management of sellar and suprasellar arachnoid cysts with stereotactic intracavitary irradiation: an expanded report of four cases. Neurosurgery 46:1518–1522
Wang JC, Heier L, Souweidane MM (2004) Advances in the endoscopic management of suprasellar arachnoid cysts in children. J Neurosurg 100(5):418–426
Weaver KD, Ewend MG (2000) Development of an arachnoid cyst after ventriculoperitoneal shunt placement. Case illustration. J Neurosurg 92:363
Wechsler D (1974) Manual for the Wechsler intelligence scale for children—revised. Psychological Corporation, New York
Zamorano L, Chavantes C, Moure F (1994) Endoscopic stereotactic interventions in the treatment of brain lesions. Acta Neurochir Suppl (Wien) 61:92–97
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Presented in part at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), 15–18 June 2005, Marburg, Germany.
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Erşahin, Y., Kesikçi, H., Rüksen, M. et al. Endoscopic treatment of suprasellar arachnoid cysts. Childs Nerv Syst 24, 1013–1020 (2008). https://doi.org/10.1007/s00381-008-0615-7
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DOI: https://doi.org/10.1007/s00381-008-0615-7