title: Suprasellar Arachnoid Cysts: Toward a New Simple Classification Based on Prognosis and Treatment Modality.
abstract: BACKGROUND
  Suprasellar arachnoid cysts (SAC) represent between 9% and 21% of pediatric arachnoid cysts. Recent improvements in magnetic resonance imaging, as well as increasing prenatal diagnosis, have allowed more precise knowledge and follow-up.
  
  
  OBJECTIVE
  To describe a novel classification of SAC.
  
  
  METHODS
  We present 35 cases of SAC treated between 1996 and 2014. Patient records and imaging studies were reviewed retrospectively to assess symptomatology, radiological findings, treatment, and long-term follow-up.
  
  
  RESULTS
  Fourteen SAC were diagnosed prenatally (39%). We observed 15 (43%) cases presenting hydrocephalus (SAC-1) removing Liliequist membrane downward. Lower forms (SAC-2) with free third ventricle were observed in 11 (31%) cases. Asymmetrical forms (SAC-3) with Sylvian or temporal extension were seen in the 9 (26%) remaining patients. Twenty-three (66%) patients were treated by ventriculocisternostomy, 3 (8.5%) by shunt surgery, and 3 (8.5%) by craniotomy. Six (17%) patients had no surgery, including 5 cases (14%) that had prenatal diagnosis. Outcomes were initially favorable in 26 cases (87%). Eight (22%) patients had endocrine abnormalities at the end of the follow-up, 3 (8.5%) had developmental delay, and 6 (17%) had minor neuropsychological disturbances.
  
  
  CONCLUSIONS
  SAC are heterogeneous entities. SAC-1 may come from an expansion of the diencephalic leaf of the Liliequist membrane. SAC-2 show a dilatation of the interpeduncular cistern and correspond to a defect of the mesencephalic leaf of the Liliequist membrane. SAC-3 correspond to the asymmetrical forms expanding to other subarachnoid spaces. Surgical treatment is not always necessary. The recognition of the different subtypes will allow choosing the best treatment option.
authors.affiliation: *Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris, France; ‡Department of Neuroradiology Necker Enfants Malades Hospital, APHP, Paris, France; §Department of Obstetrics Necker Enfants Malades Hospital, APHP, Paris, France.
authors.forename: Arthur
authors.initials: A
authors.lastname: André
authors.forename: Michel
authors.initials: M
authors.lastname: Zérah
authors.forename: Thomas
authors.initials: T
authors.lastname: Roujeau
authors.forename: Francis
authors.initials: F
authors.lastname: Brunelle
authors.forename: Thomas
authors.initials: T
authors.lastname: Blauwblomme
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Puget
authors.forename: Marie
authors.initials: M
authors.lastname: Bourgeois
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
authors.forename: Yves
authors.initials: Y
authors.lastname: Ville
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rocco
mesh_terms: D016080:Arachnoid Cysts / Q000145:classification* / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies