Outcomes of neuroendoscopy for suprasellar arachnoid cysts: a single center experiences

Abstract

Background

Arachnoid cysts are extra parenchymal, intra-arachnoid fluid collections of unknown origin, similar in content to cerebrospinal fluid. Suprasellar arachnoid cysts are a rarer localization resulting from abnormalities of the Liliequist membrane or cystic dilatation of the interpeduncular cisterna. We aimed to contribute to the literature by presenting a series of suprasellar arachnoid cyst cases with endoscopic intervention and long-term results.

Methods

This study analyzed radiographic data, clinical symptoms, surgical records, and videos of giant arachnoid cysts that underwent endoscopic surgery between 2013 and 2023. Cyst volumes and Evan’s indexes were calculated both preoperatively and postoperatively.

Results

The patient population consisted of 3 males (21.4%, 3/14 patients) and 11 females (78.5%, 11/14 patients). Their age at the time of surgery ranged from 1 year to 56 years (mean: 14.4 years). Of the total 14 patients, 4 (28.5%, 4/14 patients) were adults (age ≥ 18 years), and 10 (71.4%, 10/14 patients) were pediatric (age < 18 years). The most common presenting complaints were gait disturbance (21.4%, 3/14 patients), headache (21.4%, 3/14 patients), increased head circumference (14.2%, 2/14 patients), hormonal disorders (14.2%, 2/14 patients), seizures (14.2%, 2/14 patients), and forgetfulness (7.1%, 1/14 patients). Ventriculocystocisternostomy was performed in all patients. The most common perioperative complication was bleeding controlled by irrigation (28.5%, 4/14 patients). The mean follow-up period was 63.8 months (min:12 months-max:125 months). In the postoperative long-term follow-up, the preoperative neurologic examinations of the patients showed complete recovery, and hormonal problems returned to normal.

Conclusions

Endoscopic options for the surgery of rare giant suprasellar arachnoid cysts, especially ventriculocisternostomy, are safe, less invasive, and successful, with fewer recurrences and the need for a second operation in the long-term results of patients who underwent ventriculocisternostomy according to our experience.