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Endoscopic fenestration and coagulation shrinkage of suprasellar arachnoid cysts. Technical note
Sandeep Sood1, Martin U Schuhmann, Nedim Cakan
1Department of Pediatric Neurosurgery, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan 48201, USA. ssood@med.wayne.edu
Insights
Endoscopic fenestration and coagulation effectively shrunk suprasellar cysts in pediatric and adult patients, resolving hydrocephalus and preventing recurrence. This safe technique maintained normal growth and development post-procedure.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Minimally Invasive Surgery
Background:
- Suprasellar cysts can cause hydrocephalus and developmental issues in children.
- Previous treatments like simple fenestration have limitations, including cyst recurrence and aqueductal obstruction.
Observation:
- Eight patients (seven children, one adult) with suprasellar cysts underwent endoscopic fenestration and shrinkage coagulation.
- Four children presented with macrocephaly, and others had shunt malfunction.
Findings:
- The procedure achieved good intraoperative cyst shrinkage, maintained at a mean 35-month follow-up.
- Hydrocephalus resolved in four patients without shunts; one of four with shunts became shunt-free.
- No significant procedure-associated morbidity was observed, with growth and BMI remaining normal over a mean 52-month follow-up.
Implications:
- This combined endoscopic technique is safe and effective for treating suprasellar cysts.
- It prevents cyst recurrence and aqueductal obstruction, improving patient outcomes.
- The technique supports normal growth and development, reducing the need for long-term shunting in some cases.
Abstract:
The authors describe their experience with endoscopic fenestration of suprasellar cysts followed by shrinkage coagulation of the cysts to restore the anatomy in eight patients. Seven children ranging in age from 8 months to 4.5 years and one adult 24 years of age were treated. Four of the children presented with megacephaly and the other patients with malfunction of a shunt that had been placed previously for hydrocephalus. Endoscopic fenestration of the cyst dome was performed followed by shrinkage of the lesion by means of endoscopic coagulation. Follow-up studies included immediate and late postoperative magnetic resonance imaging, assessment of growth velocity and the body mass index (BMI), and an endocrine profile if indicated by a failure of growth or precocious puberty. Good intraoperative cyst shrinkage was achieved in all seven children. This was maintained on imaging studies at a mean follow-up period of 35 months. There was no significant procedure-associated morbidity. Hydrocephalus resolved in four patients who did not have a preexisting shunt. One of the four patients who had a shunt preoperatively became shunt free. The rest of the patients with preexisting shunts remained shunt dependent despite good resolution of the cyst. During a mean follow-up period of 52 months, the height, growth velocity, and BMI of each patient remained within two standard deviations of normal. In one patient there was a suspicion of precocious puberty, but the endocrine profile was normal; in another patient precocious puberty developed and required treatment. The presented technique is safe and prevents cyst recurrence and obstruction of the aqueduct by remnants of the cyst wall-the two main reasons for failure of a simple endoscopic fenestration.
