A Novel Bilateral Approach for Suprasellar Arachnoid Cysts: A Case Report

Abstract

The endoscopic method is used to treat suprasellar arachnoid cysts (SACs) but it is sometimes difficult to make sufficiently sized fenestrations. Creating a larger fenestration on the cyst wall is preferable to prevent closure of the stoma. In this paper, we report a novel endoscopic approach for SAC treatment in which we use bilateral burr holes to achieve a more extensive cyst fenestration. A 7-year-old girl was referred to our hospital because of incidentally detected hydrocephalus by computed tomography scans. Physical examination did not show any signs of intracranial hypertension, but a digital impression of her skull on X-ray implied chronic intracranial hypertension. Magnetic resonance imaging (MRI) revealed enlargement of both lateral ventricles and a cystic mass occupying the third ventricle. We performed cyst wall fenestration using a bilateral approach in which we created two burr holes to introduce a flexible endoscope and a rigid endoscope. The cyst wall was held by forceps with the flexible endoscope, and resection of the cyst wall was achieved by using a pair of scissors with the rigid endoscope. There were no postoperative complications, and MRI performed 1 year after treatment showed disappearance of the superior part of the cyst wall.

Treatment of refractory giant suprasellar arachnoid cyst by endoscopic expansion of a fenestrated stoma

“…Various methods have been reported for the prevention of stomal occlusion, including cauterization of the cyst itself to reduce its size [12] and partial resection of the cyst wall using two endoscopes. [6] Although the simple VCC method was not effective in the first attempt in this case, considering the method of inserting two endoscopes as being too invasive, we used the method of creating a large stoma by opening multiple small holes with electrodes and connecting them with biopsy forceps. is method can be safely used in areas where there are no important blood vessels or nerves, such as the wall between the ventricles and the cyst.…”

Probable Hydrocephalus Decompensation after Immunization with Pentavalent Vaccine: Case Report and Literature Review

“…The patient was sent awake and responsive along with the mother to the Pediatric Intensive Care Unit, where, one day later, he was discharged to the ward without symptoms. 26 The analysis of the cerebrospinal fluid collected during the operation was performed. No alterations were observed in cellularity (8 cells / 100% lymphocytes) or in glucose (48 mg/dl), identifying only hyperproteinorraquia (80 mg/dl).…”

“…The patient was sent awake and responsive along with the mother to the Pediatric Intensive Care Unit, where, one day later, he was discharged to the ward without symptoms. 26…”