Different Neuroendoscopic Modalities for Management of Suprasellar Arachnoid Cysts: Comparative Study

Arachnoid cysts account for approximately 1% of all intracranial mass lesions, with suprasellar arachnoid cysts (SACs) representing a rare subset. Hydrocephalus is the most common presentation, occurring in nearly 90% of the cases. Due to their rarity, no universal consensus exists regarding classification, optimal surgical management, or outcome assessment.

To compare outcomes of ventriculocystostomy (VC) and ventriculocystocisternostomy (VCC) in the endoscopic management of suprasellar arachnoid cysts.

This retrospective study reviewed patients with SACs who underwent endoscopic fenestration at a tertiary referral center between February 2015 and June 2025. Seventeen patients (9 males, 8 females; age range: 4-60 years), in the study, all presenting with hydrocephalus, were included. Endoscopic procedures were performed using rigid neuroendoscopy via either VC or VCC. Pre- and postoperative clinical and magnetic resonance imaging data were analyzed. Follow-up ranged from 6 to 30 months (mean: 24 months). The primary outcome was procedural success, defined as sustained clinical improvement accompanied by radiological reduction in cyst size or ventricular dilatation without need for additional surgical intervention.

Eight patients underwent VC and 9 underwent VCC. Overall success was achieved in 15 patients (88%), with success rates of 86% for VC and 89% for VCC. Two patients required subsequent ventriculoperitoneal shunt placement. Postoperative complications included cerebrospinal fluid leakage in one patient and transient diabetes insipidus in one patient.

Endoscopic fenestration is a safe and effective first-line treatment for suprasellar arachnoid cysts using either VC or VCC, with surgery reserved for symptomatic patients or those with hydrocephalus.