Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting

Abstract

The aim of this study is to define the indications to endoscopy versus other surgical procedures in the management of suprasellar arachnoid cysts from a personal series and an extensive literature review. Five symptomatic patients (two children and three adults) with suprasellar arachnoid cysts were treated by endoscopic fenestration in our neurosurgical unit. The endoscopic procedure consisted of ventricle-cyst-cisternostomy in three cases and ventricle-cystostomy in two. Four patients were cured after the endoscopic procedure alone, whereas another with rhinoliquorrhoea later required a craniotomy. The literature review includes 102 patients treated by endoscopic fenestration and 74 treated by other procedures, including microsurgical cyst resection through craniotomy (38 cases), shunt of the cyst (21 cases) and percutaneous ventricle-cystostomy (15 cases). Among the reviewed cases, the rate of cure or improvement was 90% (92 among 102 cases including ours) after endoscopy and 81% (60 among 74 cases) after other surgical procedures. The results of this study suggest that endoscopic ventricle-cyst cisternostomy is the best treatment for suprasellar arachnoid cysts, because it is less invasive, provides the best results and avoids shunt dependency in most cases.

Acquired Intraventricular Arachnoid Cyst of the Third Ventricle -Case Report-

“…1) Endoscopy is superior for the management of suprasellar arachnoid cysts compared with microsurgical procedures and shunting. 6) In the present case, endoscopic cyst fenestration and ETV provided favorable control of triventricular dilation and avoided shunt dependency in the follow-up period.…”

Ventricular endoscopy in the pediatric population: review of indications

“…These endoscopic approaches have been modified by burr hole location and use of stereotaxy to allow for fenestration of quadrigeminal [87,90], suprasellar [75,[91][92][93][94], middle fossa [79], prepontine [95], interhemispheric [96], retroclival [97], and third ventricular arachnoid cysts [94] with satisfactory outcomes.…”

“…Success of endoscopic fenestration in the setting of middle fossa arachnoid cysts is well-documented [91,98,99]. In work by Spacca et al, 90 % of the pediatric cohort treated demonstrated clinical improvement, and 73 % of cysts treated reduced in size or completely resolved following intervention [79].…”

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

“…Al-Holou et al [3] reported a 2.6% prevalence rate of arachnoid cysts in 11,738 patients, aged 18 years or younger, who had undergone brain magnetic resonance imaging (MRI). Suprasellar arachnoid cysts (SACs) comprise 2-16% of all intracranial arachnoid cysts in the pediatric age group [1,3,4]. These cysts may cause obstructive hydrocephalus, macrocrania, visual disturbance or endocrine dysfunction [5,6,7,8].…”