Objective In 1935, Barlow published the first case of a suprasellar arachnoid cyst. Fewer than
300 cases of suprasellar prepontine arachnoid cysts have been reported in the literature
as of November 2013. The surgical success rates of different methods such as craniotomy
and shunt insertion were not satisfactory enough. Therefore, endoscopic fenestration
of the cyst to the ventricle and the basal cisterns is an alternative method.
Method Between 1994 and 2012, we operated on 44 cases of suprasellar arachnoid cysts. There
were 24 female and 20 male patients and the age ranged from 6 days to 16 years (mean
5.2 years). Follow-up of the patients ranged from 1 year to 16 years. The patients
were divided into three groups: first group consisted of 38 primary cases; second
group consisted of the four patients who had a previously inserted a VP shunt system;
and the third group consisted of the two patients in whom a cystoperitoneal (CP) shunt
system had previously been inserted.
Results The outcome is evaluated according to radiological and clinical follow-up data. The
success is defined as (1) the adequacy of fenestrations and flow through fenestration
sites, (2) reduction of the cyst and ventricle size, and (3) reorientation of the
chiasma and mammillary bodies to an acceptable anatomical position. The success rate
in the first group was 100% and in the second group 75%, whereas the treatment failed
in both cases of group 3. Postoperative complications occurred in three cases. No
mortality occurred.
Conclusions Suprasellar arachnoid cysts can be treated with favorable clinical and radiological
results by using endoscopic interventions when feasible.
Keywords suprasellar arachnoid cyst; neuroendoscopic fenestration; ventriculocystocisternostomy
