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Endoscopic fenestrations for suprasellar arachnoid cysts.

Hideki Ogiwara1, Nobuhito Morota, Masahiro Joko

  • 1Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan. hideki_o@d5.dion.ne.jp

Journal of Neurosurgery. Pediatrics
|November 3, 2011
PubMed
Summary

Endoscopic ventriculocystostomy (VC) is effective for suprasellar arachnoid cysts (SACs) that communicate with basal cisterns. Preoperative cisternography helps determine the best endoscopic treatment for these cysts.

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Area of Science:

  • Neurosurgery
  • Pediatric Neurosurgery
  • Endoscopic Surgery

Background:

  • Suprasellar arachnoid cysts (SACs) are typically treated with endoscopic fenestration, primarily ventriculocystostomy (VC) or ventriculocystocisternostomy (VCC).
  • The optimal endoscopic approach for SACs remains undetermined.
  • Preoperative CT cisternography can delineate cyst-cistern communication.

Purpose of the Study:

  • To evaluate the effectiveness of endoscopic ventriculocystostomy (VC) for suprasellar arachnoid cysts (SACs) that communicate with basal cisterns.
  • To assess the utility of preoperative CT cisternography in guiding treatment selection for SACs.

Main Methods:

  • Retrospective analysis of six pediatric patients with SACs treated via endoscopic fenestration (VC or VCC) between 2004 and 2011.

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  • Review of patient demographics, clinical presentation, surgical procedures, and outcomes.
  • Preoperative CT cisternography was performed to assess cyst-basal cistern communication.

    • Main Results:

    • Five patients (mean age 18.5 months) underwent endoscopic fenestration; three had clear SAC-basal cistern communication, one had slight, and one had none.
    • Four patients underwent VC (three with communication), and two underwent VCC (slight or no communication).
    • All patients showed SAC size reduction and hydrocephalus improvement; 83% remained stable without reoperation (mean follow-up 32.7 months), including all three with communication treated with VC.

    Conclusions:

    • Preoperative cisternography is valuable for selecting the optimal endoscopic treatment for SACs.
    • For SACs with basal cistern communication, ventriculocystostomy (VC) offers an effective, safe, and simpler surgical option.