Endoscopic treatment of suprasellar cysts without hydrocephalus

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>At present, endoscopic treatment is advised as the first procedure in cases of suprasellar arachnoid cysts (SSCs) with hydrocephalus. However, the appropriate therapy for SSCs without hydrocephalus has not been fully determined yet because such cases are very rare and because it is usually difficult to perform the neuroendoscopic procedure in patients without ventriculomegaly given difficulties with ventricular cannulation and the narrow foramen of Monro. The purpose of this study was to find out the value of navigation-guided neuroendoscopic ventriculocystocisternostomy (VCC) for SSCs without lateral ventriculomegaly.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Five consecutive patients with SSC without hydrocephalus were surgically treated using endoscopic fenestration (VCC) guided by navigation between March 2014 and November 2015. The surgical technique, success rate, and patient outcomes were assessed and compared with those from hydrocephalic patients managed in a similar fashion.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The small ventricles were successfully cannulated using navigational tracking, and the VCC was accomplished in all patients. There were no operative complications related to the endoscopic procedure. In all patients the SSC decreased in size and symptoms improved postoperatively (mean follow-up 10.4 months).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Endoscopic VCC can be performed as an effective, safe, and simple treatment option by using intraoperative image-based neuronavigation in SSC patients without hydrocephalus. The image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of hydrocephalus in patients with SSC may not be a contraindication to endoscopic treatment.</jats:p></jats:sec>

Why neuroendoscopy is not for all supratentorial intracranial arachnoid cysts in children: analysis of risk factors and prognosis

“…On the other hand, there is no discussion about endoscopy as the treatment of choice for suprasellar cysts (11,28,53). The techniques described involve the creation of a cystoventricular or a deeper, cystoventriculocisternal pathway.…”

“…There is no significant difference in reductions in cystic dimensions despite the fact that cystoventriculostomy presents a higher (27)(28)(29). Explanations for the higher failure rate of the VC would be: formation of a sealing membrane in the superior fenestration after the collapse of the cyst, cystic fluid exiting through the inferior cisternal route in the VCC, presence of preoperative aqueduct stenosis that makes the relief of the apical portion of the cyst insufficient, with recurrence of hydrocephalus (53,54,58). Based on the analysis of 35 cysts operated on in their service, the Paris Group proposed a simple classification of suprasellar cysts based on prognosis and treatment modality (21).…”

Cognition in Children with Arachnoid Cysts

“…However, any study design that includes a control population that has either declined surgery or had surgery performed at a later time will be at risk of introducing selection bias. Another possible shortcoming is that external validity can be low if findings are applied to cysts with other intracranial locations than the temporal lobe [38][39][40][41]. The sample size is also too small to allow any conclusions regarding the laterality of the cyst.…”

Endoscopic Views Inside a Suprasellar Arachnoid Cyst

“…There are two main types of endoscopic surgical procedures: ventriculocystostomy, in which the goal is to establish communication between the cyst cavity and ventricles, and ventriculocystocisternostomy, in which the goal is to open the cyst into both the ventricles and cisterns. The latter being the best choice 4,7 . Typical aspect of MRI is depicted in Figures 1 and 2.…”