Artikel
Suprasellar arachnoid cyst without hydrocephalus in the neonatal patient : treatment strategy and follow-up
Supraselläre Arachnoidalzyste ohne Hydrozephalus beim Neugeborenen : Therapiestrategie und Verlauf
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Suprasellar arachnoid cysts as para-ventricular space-occupying lesions in neonates are very rare. Indication for and optimal timing of surgical interventions are discussed.
Methods
In 7 children with suprasellar cysts treated within 5 years, one case of neonatal cyst occurred. Due to preterm labour, twins were delivered by caesarean section at GW 38. The twin concerned was initially stable (Apgar 9-9-10, BW 2200g, HR 105/min, resp. rate 50/min). US imaging performed due to an increased rate of apnoeic spells within the first week of age revealed a huge suprasellar cyst (40ml) with brainstem compression but without ventricular enlargement. Spells were initially treated with caffeine-citrate, however feeding abilities did not develop accordingly. MRI delineated the cyst with right-sided contact to the frontal convexity.
Results
Because of disturbed feeding, the cyst was fenestrated by a fronto-lateral approach at day 13. Respiration and feeding abilities normalized after another week without medication. Recurrent cyst formation and ventricular dilatation necessitated re-fenestration at 16 weeks of age (endoscopic ventriculo-cysto-cisternostomy). 12 months follow-up shows normal development with reduced cyst size in MRI.
Conclusions
Staged surgical procedures adapted to the clinical picture and surgical options may lead to a successful control of cysts even in the neonatal patient.