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Treatment of suprasellar arachnoid cyst--two case reports
Insights
Suprasellar arachnoid cysts can cause developmental delays and epilepsy. Cyst-peritoneal shunting appears to be the most effective treatment for these cysts, offering good long-term outcomes.
Area of Science:
- Neuroscience
- Pediatric Neurosurgery
Background:
- Suprasellar arachnoid cysts are rare congenital malformations.
- These cysts can lead to significant neurological deficits in infants and children.
Observation:
- Two pediatric cases of suprasellar arachnoid cysts presenting with developmental delay, macrocephaly, and epilepsy are described.
- Magnetic resonance imaging (MRI) was used to visualize the cysts and their relationship to adjacent structures.
Findings:
- One patient with hydrocephalus underwent cyst fenestration, requiring subsequent subdural-peritoneal shunting. While the cyst recurred, development remained normal.
- The second patient, without hydrocephalus, underwent successful cyst-peritoneal shunting with no recurrence over 2 years and 5 months.
Implications:
- Cyst-peritoneal shunting is considered the most effective surgical intervention for suprasellar arachnoid cysts.
- Management strategies should be tailored to the individual patient's presentation, including the presence or absence of hydrocephalus.
Abstract:
A 10-month-old girl presented with mental retardation and enlarged head, and a 3-year-old girl presented with epilepsy, both due to suprasellar arachnoid cysts. Magnetic resonance imaging demonstrated the suprasellar arachnoid cyst and the relationship between the cyst and surrounding structures. The 10-month-old patient with accompanying hydrocephalus was treated by fenestration of the cyst wall into the basal cistern. Postoperatively, bilateral subdural effusion appeared and subdural-peritoneal shunting was required. Thereafter, she regained the ability to walk. Two years postoperatively, the cyst reenlarged but communication between the cyst and surrounding cisterns and her development was normal, so she has been followed conservatively. The 3-year-old patient presented without hydrocephalus and was treated by cyst-peritoneal shunting using a Codman-Medos programmable valve through craniotomy. Postoperatively, the cyst was reduced and there has been no recurrence for 2 years and 5 months. We consider that cyst-peritoneal shunting is the most effective treatment for suprasellar arachnoid cyst.