Endoscopic management of the suprasellar arachnoid cysts
Keywords:
neuroendoscopy, suprasellar arachnoid cyst, hydrocephalusAbstract
A consecutive series of twenty patients with suprasellar arachnoid cysts, mostly children under 15, and treated during 1994-2001 is presented. In all cases the membranous walls of their cystic lesions were cut and fenestrated endoscopically. Outcome was excellent in 13 cases (65%) with improvement and resolution of main local symptoms and obstructive hydrocephalus. Postoperative MRI showed near normal anatomy of the third ventricle and hypothalamus with recaptured CSF flow within the cisterns and the aqueduct in another 6 patients (30%). The procedure has failed only once. In this case it was stopped after the cyst was opened but bleeds. Later this patient needed a shunt. Including this case the overall morbidity rate was up to 15% (a mild intraventricular hemorrhage and a shortlasting ventriculitis without any serious consequences). There was no mortality. It is noteworthy that most of these patients were treated without shunts and escaped the well-known shunt related complications. Nine patients were follow upped within 1.5 years, range 3 months to 5,5 years, and all of them were free of symptoms and gained their schoolmates. The origin, the pathogenesis of these cystic CSF malformations and specific neurological, endocrinological and visual disturbances are discussed. Also the endoscopic anatomy of the suprasellar arachnoid cysts is presented. The endoscopy is both minimally invasive and effective in managing the patients with suprasellar arachnoid cysts and this option should be offered as a first tool in such cases.References
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Copyright (c) 2001 Armen Melikian, Nikita Arutyunov, A. Melnikov, Yuriy Kushel, Mariya Kolycheva
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