The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts

Clinical article

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  • 1 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
  • | 2 Department of Neurosurgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
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Object

The aim of this study was to report the long-term outcomes of patients receiving endoscopic ventriculocystocisternostomy (VCC) for suprasellar arachnoid cysts (SACs), and to analyze all published reports on outcomes of ventriculocystostomy (VC) versus VCC to compare the effectiveness of the 2 techniques.

Methods

Eleven consecutive patients with previously untreated SACs were surgically treated using endoscopic VCC. Another 2 patients were treated with VCC following ventriculoperitoneal shunt placement. Clinical imaging data were recorded. An analysis was performed of all published patient outcomes following endoscopic VC or VCC for an SAC.

Results

Developmental delay and progressive macrocephaly were the most common preoperative symptoms. At a mean clinical follow-up interval of 63 months, 10 of 11 patients undergoing primary VCC did not require reoperation. An analysis of the literature suggests that VCC may be more effective than VC. Of the 44 reported patients that underwent VC as a first treatment, 7 (16%) required reoperation, and 7 (8%) of 86 patients who underwent VCC as a first treatment required reoperation. When VC or VCC was performed following a prior surgical procedure, 4 of 11 patients undergoing VC had a treatment failure requiring reoperation. In contrast, only 2 of the 17 reported cases of VCC following a prior procedure required further treatment. The difference in reoperation rates following either primary or secondary VC was significantly higher than following primary or secondary VCC (p = 0.04).

Conclusions

The authors conclude that VCC is an effective and durable treatment for symptomatic SACs in most cases.

Abbreviations used in this paper:

CPS = cystoperitoneal shunt; SAC = suprasellar arachnoid cyst; VC = ventriculocystostomy; VCC = ventriculocystocisternostomy; VPS = ventriculoperitoneal shunt.

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