Suprasellar arachnoid cysts: management by cyst wall resection

• Published in: Neurosurgery Vol. 25; no. 4; p. 554
• Main Authors: Jones, R F, Warnock, T H, Nayanar, V, Gupta, J M
• Format: Journal Article
• Language: English
• Published: United States 01.10.1989
• Subjects: Arachnoid - pathology; Brain Diseases - diagnostic imaging; Brain Diseases - surgery; Child, Preschool; Cysts - diagnostic imaging; Cysts - surgery; Female; Humans; Infant; Male; Tomography, X-Ray Computed
• ISSN: 0148-396X
• DOI: 10.1227/00006123-198910000-00008

Five children with ventricular dilatation (4 boys, 1 girl) had features seen on computer tomographic scan that were consistent with suprasellar arachnoid cysts. All children were investigated with a CT ventriculogram and/or CT cisternogram, and no communication with the cyst was demonstrated. Three children were seen in the 1st year of life and the remaining 2 children were between 1 and 5 years of age. Hydrocephalus and developmental delay were the most common presenting features, followed by visual disturbance, squint, or ataxia. Direct surgical decompression was performed in all 5 patients to avoid long-term placement of a ventriculoperitoneal shunt. A temporary shunt was placed in 2 children because of high intracranial pressure. Direct partial excision of the cyst wall to allow long-term drainage into the basal cisterns or ventricular system was successful in all children. The presence of subdural collections postoperatively required temporary shunting in 2 children. After follow-up for between 10 and 22 months no clinical endocrinological sequelae have been detected, but 2 children have raised serum prolactin levels. Three children are developmentally delayed; one of these has regained some skills since surgery. Direct surgical decompression of suprasellar arachnoid cysts to avoid long-term shunt placement is the preferred method of surgical treatment for this condition.