Advances in the endoscopic management of suprasellar arachnoid cysts in children

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  • 1 Departments of Neurological Surgery and Radiology, and Division of Neuroradiology, New York—Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
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Object. Suprasellar arachnoid cysts present unique management problems. The authors retrospectively reviewed six cases, in which endoscopic ventriculocystocisternotomy was performed, to identify specific neuroimaging features that aid both the accurate diagnosis of this entity and the postoperative assessment of fenestration patency.

Methods. Six consecutive children underwent treatment for suprasellar arachnoid cysts. Consistent radiographic features in all cases were identified. Through a single entry site, endoscopic fenestration was performed at both the apical and basal cyst membranes. Outcome was assessed using clinical examination, quantitative changes in cyst size, and triplanar magnetic resonance (MR) imaging with flow-sensitive (long TR) sequences.

In every case, the suprasellar cysts displayed three diagnostic MR imaging features: 1) vertical displacement of the optic chiasm/tracts; 2) upward deflection of the rostral mesencephalon and mammillary bodies; and 3) effacement of the ventral pons. Two patients initially underwent placement of a ventriculoperitoneal shunt before the cysts were recognized, but MR images obtained after shunt placement revealed the cysts. In a mean follow-up period of 26.2 months, all patients improved clinically. Postoperative imaging revealed a mean cyst volume decrease of 52.7% and a return to more normal suprasellar and prepontine anatomy. Flow-sensitive MR imaging confirmed pulsation artifact at all 12 fenestration sites. There was no surgery-related death and no additional cerebrospinal fluid diversion procedure was required.

Conclusions. To aid in the accurate diagnosis of prepontine arachnoid cysts, the authors identified several pathognomonic features on sagittal MR images: vertical deflection of the optic chiasm and mammillary bodies, as well as pontine effacement. Dual endoscopic fenestration into the intraventricular compartment and basal cistern is safe, and it effectively provides symptomatic relief by decreasing the cyst size. Triplanar flow-sensitive MR imaging sequences can confirm fenestration patency without the need for cine-mode MR imaging.

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  • 1.

    Albright AL, , Pollack IF, & Adelson PD (eds): Principles and Practice of Pediatric Neurosurgery. New York: Thieme, 1999, pp 126141 Albright AL, Pollack IF, Adelson PD (eds): Principles and Practice of Pediatric Neurosurgery. New York: Thieme, 1999, pp 126–141

    • Search Google Scholar
    • Export Citation
  • 2.

    Albright L: Treatment of bobble-head doll syndrome by transcallosal cystectomy. Neurosurgery 8:593595, 1981 Albright L: Treatment of bobble-head doll syndrome by transcallosal cystectomy. Neurosurgery 8:593–595, 1981

    • Search Google Scholar
    • Export Citation
  • 3.

    Caemaert J, , Abdullah J, & Calliauw L, et al: Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir 119:6873, 1992 Caemaert J, Abdullah J, Calliauw L, et al: Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir 119:68–73, 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    Decq P, , Brugieres P, & Le Guerinel C, et al: Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696701, 1996 Decq P, Brugieres P, Le Guerinel C, et al: Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696–701, 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Dodd RL, , Barnes PD, & Huhn SL: Spontaneous resolution of a prepontine arachnoid cyst. Case report and review of the literature. Pediatr Neurosurg 37:152157, 2002 Dodd RL, Barnes PD, Huhn SL: Spontaneous resolution of a prepontine arachnoid cyst. Case report and review of the literature. Pediatr Neurosurg 37:152–157, 2002

    • Search Google Scholar
    • Export Citation
  • 6.

    Fewel ME, , Levy ML, & McComb JG: Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 25:165173, 1996 Fewel ME, Levy ML, McComb JG: Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 25:165–173, 1996

    • Search Google Scholar
    • Export Citation
  • 7.

    Fitzpatrick MO, & Barlow P: Endoscopic treatment of prepontine arachnoid cysts. Br J Neurosurg 15:234238, 2001 Fitzpatrick MO, Barlow P: Endoscopic treatment of prepontine arachnoid cysts. Br J Neurosurg 15:234–238, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Kasdon DL, , Douglas EA, & Brougham MF: Suprasellar arachnoid cyst diagnosed preoperatively by computerized tomographic scanning. Surg Neurol 7:299303, 1977 Kasdon DL, Douglas EA, Brougham MF: Suprasellar arachnoid cyst diagnosed preoperatively by computerized tomographic scanning. Surg Neurol 7:299–303, 1977

    • Search Google Scholar
    • Export Citation
  • 9.

    Kirollos RW, , Javadpour M, & May P, et al: Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713718, 2001 Kirollos RW, Javadpour M, May P, et al: Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718, 2001

    • Search Google Scholar
    • Export Citation
  • 10.

    Miyajima M, , Arai H, & Okuda O, et al: Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases. J Neurosurg 93:6267, 2000 Miyajima M, Arai H, Okuda O, et al: Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases. J Neurosurg 93:62–67, 2000

    • Search Google Scholar
    • Export Citation
  • 11.

    Osborn AG: Diagnostic Neuroradiology. St. Louis: Mosby, 1994, p 481 Osborn AG: Diagnostic Neuroradiology. St. Louis: Mosby, 1994, p 481

  • 12.

    Pierre-Kahn A, , Capelle L, & Brauner R, et al: Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg 73:355359, 1990 Pierre-Kahn A, Capelle L, Brauner R, et al: Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg 73:355–359, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Rappaport ZH: Suprasellar arachnoid cysts: options in operative management. Acta Neurochir 122:7175, 1993 Rappaport ZH: Suprasellar arachnoid cysts: options in operative management. Acta Neurochir 122:71–75, 1993

    • Search Google Scholar
    • Export Citation
  • 14.

    Rengachary SS, & Watanabe I: Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:6183, 1981 Rengachary SS, Watanabe I: Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61–83, 1981

    • Search Google Scholar
    • Export Citation
  • 15.

    Santamarta D, , Aguas J, & Ferrer E: The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slitvalve mechanism. Minim Invasive Neurosurg 38:133137, 1995 Santamarta D, Aguas J, Ferrer E: The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slitvalve mechanism. Minim Invasive Neurosurg 38:133–137, 1995

    • Search Google Scholar
    • Export Citation
  • 16.

    Schroeder HW, & Gaab MR: Endoscopic observation of a slitvalve mechanism in a suprasellar prepontine arachnoid cyst: case report. Neurosurgery 40:198200, 1997 Schroeder HW, Gaab MR: Endoscopic observation of a slitvalve mechanism in a suprasellar prepontine arachnoid cyst: case report. Neurosurgery 40:198–200, 1997

    • Search Google Scholar
    • Export Citation
  • 17.

    Schroeder HW, , Gaab MR, & Niendorf WR: Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85:293298, 1996 Schroeder HW, Gaab MR, Niendorf WR: Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85:293–298, 1996

    • Search Google Scholar
    • Export Citation
  • 18.

    Sommer IE, & Smit LM: Congenital supratentorial arachnoidal and giant cysts in children: a clinical study with arguments for a conservative approach. Childs Nerv Syst 13:812, 1997 Sommer IE, Smit LM: Congenital supratentorial arachnoidal and giant cysts in children: a clinical study with arguments for a conservative approach. Childs Nerv Syst 13:8–12, 1997

    • Search Google Scholar
    • Export Citation

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