Suprasellar arachnoid cysts: management by cyst wall resection
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R F Jones1, T H Warnock, V Nayanar
1Department of Neurology, Prince of Wales Children's Hospital, Randwick, New South Wales, Australia.
Insights
Direct surgical decompression effectively treats suprasellar arachnoid cysts in children, avoiding long-term shunts. This approach led to successful outcomes in all five patients studied.
Area of Science:
- Pediatric Neurosurgery
- Neuroimaging
- Cystic Brain Lesions
Background:
- Suprasellar arachnoid cysts can cause hydrocephalus and developmental delay in children.
- Surgical intervention is often necessary to manage these cysts and their associated symptoms.
Observation:
- Five pediatric patients (4 boys, 1 girl) presented with ventricular dilatation suggestive of suprasellar arachnoid cysts.
- Common symptoms included hydrocephalus, developmental delay, visual disturbances, and ataxia.
- CT ventriculography and cisternography confirmed no cyst-ventricular communication.
Findings:
- Direct surgical decompression with partial cyst wall excision was performed in all five children.
- This procedure successfully achieved long-term drainage into basal cisterns or the ventricular system for all patients.
- No long-term ventriculoperitoneal shunts were required, though temporary shunting was needed for two patients due to high intracranial pressure or postoperative subdural collections.
Implications:
- Direct surgical decompression is a preferred method for treating pediatric suprasellar arachnoid cysts, potentially avoiding long-term shunt dependency.
- While most patients showed no endocrine sequelae, two had elevated prolactin levels.
- Long-term developmental outcomes varied, with three children showing delays, though one demonstrated skill recovery post-surgery.
Abstract:
Five children with ventricular dilatation (4 boys, 1 girl) had features seen on computer tomographic scan that were consistent with suprasellar arachnoid cysts. All children were investigated with a CT ventriculogram and/or CT cisternogram, and no communication with the cyst was demonstrated. Three children were seen in the 1st year of life and the remaining 2 children were between 1 and 5 years of age. Hydrocephalus and developmental delay were the most common presenting features, followed by visual disturbance, squint, or ataxia. Direct surgical decompression was performed in all 5 patients to avoid long-term placement of a ventriculoperitoneal shunt. A temporary shunt was placed in 2 children because of high intracranial pressure. Direct partial excision of the cyst wall to allow long-term drainage into the basal cisterns or ventricular system was successful in all children. The presence of subdural collections postoperatively required temporary shunting in 2 children. After follow-up for between 10 and 22 months no clinical endocrinological sequelae have been detected, but 2 children have raised serum prolactin levels. Three children are developmentally delayed; one of these has regained some skills since surgery. Direct surgical decompression of suprasellar arachnoid cysts to avoid long-term shunt placement is the preferred method of surgical treatment for this condition.