Navigated laser-assisted endoscopic fenestration of a suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome

Case report

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✓ The authors present the case of a 2-year-old boy with bobble-head doll syndrome (BHDS) associated with a large suprasellar arachnoid cyst and enlarged ventricles, who was successfully treated with neuronavigated laser-assisted endoscopic ventriculocystocisternostomy.

The clinical history, surgical treatment, and clinical follow up of the patient are described. A navigated laser-assisted endoscopic ventriculocystocisternostomy of the suprasellar arachnoid cyst led to cessation of the head bobbing, and notable reduction of the cyst and ventricles was visible on the postoperative magnetic resonance images.

Caused by a suprasellar arachnoid cyst, BHDS can be successfully treated with navigated laser-assisted endoscopic ventriculocystocisternostomy. The advantages of this procedure are minimal invasiveness and facilitated guidance of the neuronavigation system to the target area when normal anatomical landmarks are not visible.

Abbreviations used in this paper: BHDS = bobble-head doll syndrome; MR = magnetic resonance.

Article Information

Address reprint requests to:Janneke van Beijnum, M.D., Department of Neurosurgery G03.124, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. email:

© AANS, except where prohibited by US copyright law.



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    Sagittal (left), axial (center), and coronal (right) MR images obtained preoperatively showing a large suprasellar arachnoid cyst. Substantial compression on the fornix, corpus callosum, pons, and mesencephalon has caused prominently enlarged lateral ventricles.

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    Endoscopic view showing a large fenestration in the lower cyst wall and the membrane of Lillequist revealing the prepontine cistern and the pons, basilar artery, and oculomotor nerve.

  • View in gallery

    Sagittal (left), axial (center), and coronal (right) MR images obtained 2 months postoperatively showing a significantly decreased suprasellar arachnoid cyst and mass effect of the cyst, along with reduction of the hydrocephalus.


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