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
Author

Henry Schroeder

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

All cases by: Henry Schroeder