• 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