Ventriculo-Cysto-Cisternostomy in the Treatment of Suprasellar Arachnoid Cysts

Objective In 1935, Barlow published the first case of a suprasellar arachnoid cyst. Fewer than 300 cases of suprasellar prepontine arachnoid cysts have been reported in the literature as of November 2013. The surgical success rates of different methods such as craniotomy and shunt insertion were not satisfactory enough. Therefore, endoscopic fenestration of the cyst to the ventricle and the basal cisterns is an alternative method.

Method Between 1994 and 2012, we operated on 44 cases of suprasellar arachnoid cysts. There were 24 female and 20 male patients and the age ranged from 6 days to 16 years (mean 5.2 years). Follow-up of the patients ranged from 1 year to 16 years. The patients were divided into three groups: first group consisted of 38 primary cases; second group consisted of the four patients who had a previously inserted a VP shunt system; and the third group consisted of the two patients in whom a cystoperitoneal (CP) shunt system had previously been inserted.

Results The outcome is evaluated according to radiological and clinical follow-up data. The success is defined as (1) the adequacy of fenestrations and flow through fenestration sites, (2) reduction of the cyst and ventricle size, and (3) reorientation of the chiasma and mammillary bodies to an acceptable anatomical position. The success rate in the first group was 100% and in the second group 75%, whereas the treatment failed in both cases of group 3. Postoperative complications occurred in three cases. No mortality occurred.

Conclusions Suprasellar arachnoid cysts can be treated with favorable clinical and radiological results by using endoscopic interventions when feasible.

Keywords suprasellar arachnoid cyst; neuroendoscopic fenestration; ventriculocystocisternostomy