Suprasellar Versus Third Ventricular Cysts: Anatomic and Surgical Considerations

Intracranial arachnoid cysts are benign cerebrospinal fluid-filled sacs that occur in 2.6% of children and 1.4% of adults. Suprasellar arachnoid cysts (SACs) represent between 9% and 21% of pediatric arachnoid cysts. These are often confused with the less common third ventricular cysts (3VCs). Both can grow and cause obstructive hydrocephalus, requiring urgent treatment. The aim of surgical treatment was to re-establish cerebrospinal fluid circulation. In this article, we describe and contrast the imaging characteristics of SAC and 3VC, and show stepwise endoscopic surgical approaches for each.

We show examples of patients with SAC and 3VC who presented with symptoms of obstructive hydrocephalus and who underwent endoscopic intraventricular resection of the cysts leading to long-term resolution of the hydrocephalus and symptoms. Magnetic resonance imaging of the anatomic differences and video demonstrations of the surgical approaches reveal important features that distinguish between the 2 cysts.

Safe endoscopic treatment of SAC and 3VC requires a thorough understanding of how each distorts the anatomy of the third ventricle and suprasellar cistern, and a stepwise surgical approach based on this anatomy.