Endoscopic fenestration of suprasellar arachnoid cyst

943 944 Henry Schroeder

Endoscopic 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
Pre op
Post op

Henry Schroeder

Chairman, Department of Neurosurgery, Ernst-Moritz-Arndt University, Greifswald, Germany

All cases by: Henry Schroeder