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Unusual intraventricular herniation of the suprasellar arachnoid cyst and its successful endoscopic management
G Melikian1, N V Arutiunov, A V Melnikov
1Department of Pediatric Neurosurgery, Burdenko Neurosurgical Institute, Moscow, Russia. melikian@nsi.ru
Insights
A child with a benign intrinsic tectal tumor experienced a rare intraventricular cyst after shunt placement. Endoscopic fenestration successfully treated this obstructive hydrocephalus complication.
Area of Science:
- Neuroscience
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Obstructive hydrocephalus in children requires prompt management.
- Shunt placement is a common intervention for hydrocephalus.
- Benign intrinsic tectal tumors can cause obstructive hydrocephalus.
Observation:
- A child with a tectal tumor and hydrocephalus developed a large intraventricular cystic lesion post-shunt insertion.
- This complication was associated with subdural-subarachnoid bleeding.
- The lesion was identified as an entrapped chiasmatic cistern disrupting the septum pellucidum.
Findings:
- The entrapped chiasmatic cistern progressively filled the anterior horn of the lateral ventricle.
- Successful endoscopic treatment involved cyst fenestration and third ventriculostomy.
- This approach resolved the unusual cyst formation and relieved hydrocephalus.
Implications:
- Highlights a rare complication of shunt surgery in pediatric hydrocephalus.
- Demonstrates the efficacy of endoscopic techniques for complex intraventricular lesions.
- Informs management strategies for obstructive hydrocephalus and associated cystic formations.
Abstract:
A child with a benign intrinsic tectal tumor and obstructive hydrocephalus developed a huge intraventricular cystic lesion following insertion of a shunt, which was complicated by a subdural-subarachnoid bleeding. The lesion was identified to be an entrapped chiasmatic cistern, which disrupted the septum pellucidum in front of the third ventricle and filled gradually the anterior horn of the lateral ventricle. The condition was successfully treated endoscopically by fenestration of the cyst and a third ventriculostomy. Probable mechanisms of such unusual cyst formation and general management strategies in patients with obstructive hydrocephalus are discussed.
