Endoscopic treatment of suprasellar arachnoid cysts.
OBJECTIVE
Arachnoid cysts constitute 1% of all intracranial mass lesions not resulting from trauma. Suprasellar arachnoid cysts (SACs) are uncommon. Obstructive hydrocephalus is the most common cause of initial symptoms and occurs in almost 90% of the patients with suprasellar arachnoid cyst. We report on 17 patients with suprasellar arachnoid cyst who were treated with neuroendoscopic intervention.


METHODS
Seventeen patients with SAC had been operated on between 1999 and 2007 in our institution. Five patients had previously undergone shunting procedures or craniotomy. Nine boys and eight girls ranged in age from 4 months to 17 years (mean 53.2 months). All patients had hydrocephalus. A wide ventriculocystostomy (VC) or a ventriculo-cysto-cisternostomy (VCC) was done by using rigid neuroendoscopes. Psychometric evaluation was administered postoperatively, when possible. Follow-up of the patients ranged from 6 months to 7 years (mean 41.6 months).


RESULTS
Of the 17 patients, 12 underwent endoscopic procedure as the primary surgery. VC only was performed in the first patient. In the remaining 16 patients, VCC was done. A slit-valve mechanism was observed in 14 patients. Three patients needed a VP shunt, despite a successful VCC. Three of five patients, younger than 1 year of age became shunt dependent and none of the patients older than 1 year of age needed shunting. In four patients presented with shunt malfunction, the shunts were removed after endoscopic surgery. Only one subject's total score was under the normal IQ limits but her subtests scores were heterogeneous. However, there was marked discrepancy among her subtests scores.


CONCLUSIONS
Endoscopic surgery should be the first choice in the management of SACs. Neuroendoscopic VCC is successful in the majority of the cases.
Erşahin
Yusuf
Y
Division of Pediatric Neurosurgery, Department of Child Psychiatry, Faculty of Medicine, Ege University, 35100 Bornova, Izmir, Turkey. yusuf.ersahin@ege.edu.tr
Kesikçi
Hande
H
Rüksen
Mete
M
Aydin
Cahide
C
Mutluer
Saffet
S
D000293:Adolescent; D016080:Arachnoid Cysts / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D014696:Ventriculostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*