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Endoscopic transcranial transventricular management of intracranial suprasellar arachnoid cyst: An outcome analysis
Subhas K Konar1, Kevin Sudevan1, Nishanth Sadashiva1
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
Objective:
Endoscopic management is the treatment option for patients with symptomatic suprasellar arachnoid cysts. The study aims to evaluate the outcome of endoscopic management of suprasellar arachnoid cysts and predictors of outcome.
Methodology:
A retrospective study was performed over ten years in a tertiary care center in the southern part of India. A total of 41 patients were recruited for analysis. We have performed the analysis of the predictive factors related to surgical outcome.
Results:
The mean age was 6.4 years (SD:4.87). Twenty-three cases were female, eighteen were male. The common clinical features increased intracranial pressure and headache (39%). Type 1 cyst morphology predominated (32, 78.0%), whereas Type 3 cyst morphology was less common (5, 12.2%). The most frequent procedure was ventriculo-cysto-cystostomy (VCC) (35, 85.4%), but ventriculo-cystostomy (VC) was performed in six patients (14.6%). At six months, clinical improvement noted in 58.5% of patients and cyst reduction < 50% in 80.5% and > 50% in 19.5% of patients. Presence of vomiting (OR:56.6, CI: 6.454-1623) p = 0.00001), pre-operative cyst volume more than or equal to 35 cc (OR:8.77, CI: 1.536-73.9) p = 0.01) and presence of transparent membrane (OR:27.41, CI: 2.772-809.4 p = 0.003) strongly associated with cyst volume reduction > 50% in univariate analysis. Only presence of vomiting (CI: 0.003-0.51, p = 0.01) is strongly related to > 50% reduction in regression analysis. The need for a shunt is substantially correlated with presence of headache (OR:10.26, CI:1.246-269.1, p = 0.02), surgical type (VC) (OR:27.2, CI:3.175, 337.7, p = 0.002), and complications like presence of CSF leak, meningitis (OR:51.7, CI: 4.623, 1708, p = 0.0007).
Conclusions:
Endoscopic management of suprasellar arachnoid cysts is a safe procedure. It is a superior alternative to shunt surgery and shunt-related complications. For a suprasellar arachnoid cyst, VCC is a better procedure than VC. Significant cyst volume reduction is strongly predicted by preoperative cyst volume and transparent cyst membrane.
