Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting

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.