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Suprasellar arachnoid cysts: management by cyst wall resection
R F Jones1, T H Warnock, V Nayanar
1Department of Neurology, Prince of Wales Children's Hospital, Randwick, New South Wales, Australia.
Neurosurgery
|October 1, 1989
Summary
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.