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[Suprasellar arachnoid cyst--report of a case (author's transl)]
Insights
A pediatric suprasellar arachnoid cyst caused hydrocephalus and vision loss. Microsurgical cyst wall removal proved superior to shunting, preventing recurrence and complications like subdural effusion.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Ophthalmology
Background:
- Suprasellar arachnoid cysts are rare intracranial lesions.
- These cysts can cause significant neurological and visual impairment in children.
Observation:
- A 4-year-old boy presented with hydrocephalus, visual acuity impairment, and strabismus due to a suprasellar arachnoid cyst.
- Initial management involved a ventriculoperitoneal (V-P) shunt, followed by microsurgical cyst wall removal.
- Post-operative complications included subdural effusion, managed with subdural-peritoneal (S-P) shunts.
Findings:
- Microsurgical removal of the cyst wall resulted in cyst disappearance and improved visual acuity.
- Analysis of 45 cases suggests direct cyst wall removal is preferable to V-P shunting for primary treatment.
- Removal of the V-P shunt system may prevent post-operative subdural effusion.
Implications:
- Direct microsurgical excision is the recommended primary treatment for pediatric suprasellar arachnoid cysts.
- V-P shunting may be considered for recurrent cysts, while S-P shunts can manage complications.
- This case highlights the importance of surgical approach selection for optimal patient outcomes.
Abstract:
A 4-year-old boy with suprasellar arachnoid cyst was reported. At the age of 30-month-old his aunt was aware of his squint. During the observation by ophthalmologists from the age of 1y. to 3y., enlargement of the head and impairment of the visual acuity were manifested. Cranial CT scan revealed the enlargement of the ventricular system and a round low density area located superior to the sella. Absorption coefficient of the lesion was similar to that of the cerebrospinal fluid. No abnormal contrast enhancement was seen. Examination revealed the head circumference of 53.3 cm larger than doubled standard deviation, the right external strabismus, impaired vision (R:0.03, L:0.3) and optic atrophy but no other neurological signs. Cerebral angiography showed suprasellar mass lesion. After the ventriculography with water-soluble contrast medium, V-P shunt operation was performed and then the patient was transferred to the CT room. CSF enhanced CT scan showed no communication between the ventricles and the cyst. By frontotemporal approach, microsurgical removal of the cystwall was performed and the histological diagnosis was arachnoid membrane. Several days after the operation, bilateral subdural effusion was seen on CT scan and was treated with bilateral S-P shunt and the removal of V-P shunt. Follow up CT scan disclosed the disappearance of the subdural effusion and the suprasellar cyst. The visual acuity was improved well and the endocrinological study was normal. Analysis of the 45 reported cases of suprasellar arachnoid cyst suggested that direct removal of the cyst wall is better than the V-P shunt operation and the cyst shunting is advisable for repeat recurrence of the cyst. Removal of the ventricular shunting system may be effective for the prevention of the subdural effusion as a complication after direct operation.