Endoscopic fenestration of suprasellar arachnoid cyst
https://www.neuroendo.net/wp-content/uploads/2019/01/Endoscopic-fenestration-of-suprasellar-arachnoid-cyst-feature-img.jpg 943 944 Henry Schroeder Henry Schroeder http://www.neuroendo.net/wp-content/uploads/2017/10/SchroederH-96x96.jpgEndoscopic fenestration of suprasellar arachnoid cyst
Diagnosis: Suprasellar arachnoid cyst
- 9-year-old girl
- Increasing headache for one year
- MR scan: large suprasellar arachnoid cyst asymmetrical ventricular dilatation
- Endoscopic ventriculo-cysto-cisternostomy was performed by fenestrating the wall of the cyst proximally and distally
- Postoperative MR scan at 3 months showed the wide fenestration and reduction of the volume of the cyst and the ventricles
- The patient’s symptoms resolved completely
Equipment Used
- Storz Lotta endoscope
- Bipolar diathermy electrode
- Endoscopic scissors
- Decq forceps
Surgical Tips
- Approach was done through the larger lateral ventricle, on this case the left.
- The suprasellar arachnoid cyst is seen filling the foramen of Monro
- A ventriculo-cystostomy is performed by fenestrating the cyst wall as widely as possible with the bipolar electrode and cutting with scissors as it is usually thick
- The distal cyst wall in the prepontine cistern is fenestrated as well to create cysto-cisternostomy
- Commonly a valve mechanism is seen in the cyst wall in the prepontine area
- Care should be taken to avoid using the bipolar diathermy lead near large vessels such as the basilar artery