Article
Endoscopic remodelling of third ventricular floor as treatment strategy for suprasellar arachnoid cysts
Endoskopisches "Remodelling" des Bodens des dritten Ventrikels als Behandlungsstrategie von suprasellären Arachnoidalzysten
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Authors
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M. U. Schuhmann
- Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, USA
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M. Galarza
- Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, USA
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S. D. Ham
- Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, USA
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S. Sood
- Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, USA
| Published: | May 4, 2005 |
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Outline
Text
Objective
To present our experience in treating suprasellar arachnoid cysts with endoscopic fenestration followed by shrinkage coagulation of the cyst dome in a way that reconstructs the floor of the third ventricle.
Methods
Seven children and one adult were treated with the technique. Four patients had presented with macrocephaly or raised intracranial pressure symptoms and the rest had presented with malfunction of a shunt that had previously been placed for hydrocephalus. Endoscopic fenestration of the cyst dome was performed. This was followed by an extensive shrinkage of the cyst walls by bipolar coagulation, leading to a re-construction the third ventricular floor below the level of the aqueduct. The approach thus eliminates any floating cyst wall parts within the third ventricular space. Follow-up studies included immediate and late post op MRI, growth velocity and Body Mass Index (BMI) monitoring and endocrine profile if indicated.
Results
Adequate intra-operative cyst shrinkage was achieved in all except 2 of the chronically shunted patients. The operative result was maintained on follow-up imaging studies (median follow-up 39 months). There was no significant procedure associated morbidity. Hydrocephalus resolved in all 4 patients who had no preexisting shunt and one of the previously shunted patients became shunt free. The remaining 3 shunted patients remained shunt dependant despite a proven communication between the intraventricular and the subarachnoid space and a good resolution of the cyst. Height, growth velocity and BMI remained with 2 SD of normal at follow-up; one patient had suggestion of precocious puberty but the endocrine profile was normal; another patient developed precocious puberty and required treatment.
Conclusions
The presented technique is safe and prevents the two main reasons for failure of simple endoscopic fenestration; cyst recurrences by reclosure or obstruction of the aqueductal orifice by cyst wall remnants. It, however, cannot resolve an underlying CSF circulation defects beyond the third ventricle, e.g. as a result of chronic shunting. Furthermore, longstanding shunting and the resulting thickened cyst walls can prevent radical cyst wall shrinkage.
