Endoscopic Ventriculocystocisternostomy Research Articles

Suprasellar cyst after subarachnoid intraventricular hemorrhage and ventriculoperitoneal shunt implantation

The objective is to describe a rare clinical case of a suprasellar cyst formed after implantation of a ventriculoperitoneal shunt. Clinical observation . A female patient, 51 years, suffered non-traumatic subarachnoid intraventricular hemorrhage, acute obstructive and subsequently normal pressure hydrocephalus requiring implantation of a ventriculoperitoneal shunt. In several years, the patient developed a suprasellar cyst manifesting through cerebral symptoms. Results . Two (2) surgeries were performed. During the 1st surgical intervention, endoscopic ventriculostomy was performed with positive outcome (full regression of the symptoms). After 6 months, cyst recurrence was confirmed, and endoscopic ventriculocystocisternostomy with replacement of a low pressure pump with intermediate pressure pump was performed. Full regression of neurological disorders was observed; magnetic resonance imaging did not show cyst recurrence 6 months after the 2 nd surgery. Conclusion . This clinical observation expands our knowledge on the diversity of mechanisms of suprasellar arachnoid cyst formation and demonstrated effectiveness of one of the techniques for prevention of cyst formation in the context of ventriculoperitoneal shunt.

Letter to the Editor Regarding “Reversible Severe Brainstem Herniation and Obstructive Hydrocephalus from Cystoperitoneal Shunt Overdrainage”

Suprasellar arachnoid cysts are a rare but important pediatric neurosurgical pathology with unknown ideal management. They have been previously managed with techniques including open craniotomy with microsurgical fenestration, cystoperitoneal shunting, endoscopic ventriculocystostomy, and endoscopic ventriculocystocisternostomy (VCC), without a consistent consensus on the best surgical approach. We present an overview of the literature on surgical management of suprasellar arachnoid cysts.A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted for all articles evaluating treatment modalities for suprasellar arachnoid cysts, using PubMed, OVID, and Web of Science.Twenty-five articles on management of suprasellar arachnoid cysts in children were identified. Few published studies exist that examine different types of surgical management across a single institution. The majority of studies reported best clinical outcomes in patients treated with endoscopic approaches when compared with microsurgical fenestration or cystoperitoneal shunting, reporting lower rates of infection, shunt dependence, and need for revision in addition to better resolution of clinical symptoms. Furthermore, most studies argue that VCC is superior to ventriculocystostomy, offering better long-term improvement of clinical symptoms and lower rates of failure.This study examines the current literature on suprasellar arachnoid cyst surgical management to conclude that an endoscopic approach in comparison with other approaches has the best outcomes. Of the endoscopic options available, VCC provides patients with the best long-term resolution of symptoms and the lowest need for revision. These findings should be further investigated with larger multicenter studies to further compare different surgical techniques and outcomes.

In Reply to the Letter to the Editor Regarding “Reversible Severe Brainstem Herniation and Obstructive Hydrocephalus from Cystoperitoneal Shunt Overdrainage”

Suprasellar arachnoid cysts are a rare but important pediatric neurosurgical pathology with unknown ideal management. They have been previously managed with techniques including open craniotomy with microsurgical fenestration, cystoperitoneal shunting, endoscopic ventriculocystostomy, and endoscopic ventriculocystocisternostomy (VCC), without a consistent consensus on the best surgical approach. We present an overview of the literature on surgical management of suprasellar arachnoid cysts.A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted for all articles evaluating treatment modalities for suprasellar arachnoid cysts, using PubMed, OVID, and Web of Science.Twenty-five articles on management of suprasellar arachnoid cysts in children were identified. Few published studies exist that examine different types of surgical management across a single institution. The majority of studies reported best clinical outcomes in patients treated with endoscopic approaches when compared with microsurgical fenestration or cystoperitoneal shunting, reporting lower rates of infection, shunt dependence, and need for revision in addition to better resolution of clinical symptoms. Furthermore, most studies argue that VCC is superior to ventriculocystostomy, offering better long-term improvement of clinical symptoms and lower rates of failure.This study examines the current literature on suprasellar arachnoid cyst surgical management to conclude that an endoscopic approach in comparison with other approaches has the best outcomes. Of the endoscopic options available, VCC provides patients with the best long-term resolution of symptoms and the lowest need for revision. These findings should be further investigated with larger multicenter studies to further compare different surgical techniques and outcomes.

Management of Suprasellar Arachnoid Cysts in Children: A Systematic Literature Review Highlighting Modern Endoscopic Approaches

Suprasellar arachnoid cysts are a rare but important pediatric neurosurgical pathology with unknown ideal management. They have been previously managed with techniques including open craniotomy with microsurgical fenestration, cystoperitoneal shunting, endoscopic ventriculocystostomy, and endoscopic ventriculocystocisternostomy (VCC), without a consistent consensus on the best surgical approach. We present an overview of the literature on surgical management of suprasellar arachnoid cysts. A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted for all articles evaluating treatment modalities for suprasellar arachnoid cysts, using PubMed, OVID, and Web of Science. Twenty-five articles on management of suprasellar arachnoid cysts in children were identified. Few published studies exist that examine different types of surgical management across a single institution. The majority of studies reported best clinical outcomes in patients treated with endoscopic approaches when compared with microsurgical fenestration or cystoperitoneal shunting, reporting lower rates of infection, shunt dependence, and need for revision in addition to better resolution of clinical symptoms. Furthermore, most studies argue that VCC is superior to ventriculocystostomy, offering better long-term improvement of clinical symptoms and lower rates of failure. This study examines the current literature on suprasellar arachnoid cyst surgical management to conclude that an endoscopic approach in comparison with other approaches has the best outcomes. Of the endoscopic options available, VCC provides patients with the best long-term resolution of symptoms and the lowest need for revision. These findings should be further investigated with larger multicenter studies to further compare different surgical techniques and outcomes.

Transventricular Endoscopic Management of a Suprasellar Arachnoid Cyst Causing Precocious Puberty

Suprasellar cysts arachnoid cysts (SSAC) are relatively uncommon making up less than 2% of all arachnoid cysts. Suprasellar arachnoid cyst causing precocious puberty is infrequent. The pathogenesis remains unknown in the majority of patients with precocious puberty. Endoscopic ventriculocystocisternostomy procedure is an effective and minimally invasive method in the treatment of these cysts. This report describes a 7-year old male who had a huge intracranial arachnoid cyst with initial symptoms and signs of sexual precocity. Magnetic resonance image (MRI) of the brain revealed the presence of large suprasellar cystic lesion. Case Study Badri et al.; BJMMR, 7(9): 795-800, 2015; Article no.BJMMR.2015.390 796

Institutional experience of endoscopic suprasellar arachnoid cyst fenestration

Suprasellar arachnoid cysts can differ from other arachnoid cysts in several ways, making a separate analysis of these cysts worthwhile. Herein, we present the outcome and perform volumetric analysis of six children with suprasellar arachnoid cysts treated with endoscopic ventriculocystocisternostomy in order to evaluate the long-term outcomes. Operative and postoperative data were retrospectively reviewed for six patients harboring suprasellar arachnoid cysts. Imaging was then used to follow success of surgical intervention. Six patients with suprasellar arachnoid cysts underwent ventriculocystocisternostomy. Presenting symptoms were headaches in three patients, developmental delay in another, and an incidental finding in the remaining patients. All patients had enlarged lateral and third ventricles on initial imaging. Average age at presentation was 145.7 months (65.4-250.2). Follow-up was an average of 46.5 months (3-84). The average cyst size was 153.96 cm(3) (42.98-369.20) preoperatively and an average of 39.92 cm(3) (3.20-101.47) at follow-up. Based on our experience, suprasellar arachnoid cyst treatment with ventriculocystocisternostomy is an adequate surgical intervention. Suprasellar and third ventricular size does respond to the surgical intervention at long-term follow-up.

The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts

The aim of this study was to report the long-term outcomes of patients receiving endoscopic ventriculocystocisternostomy (VCC) for suprasellar arachnoid cysts (SACs), and to analyze all published reports on outcomes of ventriculocystostomy (VC) versus VCC to compare the effectiveness of the 2 techniques. Eleven consecutive patients with previously untreated SACs were surgically treated using endoscopic VCC. Another 2 patients were treated with VCC following ventriculoperitoneal shunt placement. Clinical imaging data were recorded. An analysis was performed of all published patient outcomes following endoscopic VC or VCC for an SAC. Developmental delay and progressive macrocephaly were the most common preoperative symptoms. At a mean clinical follow-up interval of 63 months, 10 of 11 patients undergoing primary VCC did not require reoperation. An analysis of the literature suggests that VCC may be more effective than VC. Of the 44 reported patients that underwent VC as a first treatment, 7 (16%) required reoperation, and 7 (8%) of 86 patients who underwent VCC as a first treatment required reoperation. When VC or VCC was performed following a prior surgical procedure, 4 of 11 patients undergoing VC had a treatment failure requiring reoperation. In contrast, only 2 of the 17 reported cases of VCC following a prior procedure required further treatment. The difference in reoperation rates following either primary or secondary VC was significantly higher than following primary or secondary VCC (p = 0.04). The authors conclude that VCC is an effective and durable treatment for symptomatic SACs in most cases.

Navigated laser-assisted endoscopic fenestration of a suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome

The authors present the case of a 2-year-old boy with bobble-head doll syndrome (BHDS) associated with a large suprasellar arachnoid cyst and enlarged ventricles, who was successfully treated with neuronavigated laser-assisted endoscopic ventriculocystocisternostomy. The clinical history, surgical treatment, and clinical follow up of the patient are described. A navigated laser-assisted endoscopic ventriculocystocisternostomy of the suprasellar arachnoid cyst led to cessation of the head bobbing, and notable reduction of the cyst and ventricles was visible on the postoperative magnetic resonance images. Caused by a suprasellar arachnoid cyst, BHDS can be successfully treated with navigated laser-assisted endoscopic ventriculocystocisternostomy. The advantages of this procedure are minimal invasiveness and facilitated guidance of the neuronavigation system to the target area when normal anatomical landmarks are not visible.

Suprasellar arachnoid cyst with bobble-head doll movements: A management option

The authors describe their experience with endoscopic ventriculo-cysto-cisternostomy and placement of cisterno-cysto-venticulo peritoneal shunt for suprasellar arachnoid cyst for a child with bobble head doll movements. The abnormal head movements improved and follow up imaging showed reduction in the cyst and ventricular size. The benefits of minimally invasive endoscopic ventriculocystocisternostomy with endoscopic guided placement of cisterno-cysto-ventriculo peritoneal shunt is been discussed. <br>

Bobble-head doll syndrome successfully treated with an endoscopic ventriculocystocisternostomy

The bobble-head doll syndrome (BHDS) is characterized by a back-and-forth movement of the head with a frequency of 2 to 3 Hz, which increases during walking and excitement and decreases during concentration. The head movements are accompanied by macrocephaly, ocular disturbances, psychomotor retardation, and sometimes endocrine dysfunction. The BHDS is frequently associated with a suprasellar arachnoid cyst. The authors present the case of a 4-year-old patient with BHDS; an endoscopic cystoventriculostomy was performed by fenestrating a cyst in the suprasellar region. After wide fenestration of the cyst wall that was protruding and obstructing the foramen of Monro, the cyst was entered with the endoscope and a small, natural, valvelike communication of the cyst with the basal prepontine cistern was seen close to the basilar artery. This communication was widened by balloon dilation. After completion of the ventriculocystocisternostomy, the cyst collapsed and the obstruction of the aqueduct was resolved. In view of the source mechanism and cerebrospinal fluid dynamics of the suprasellar arachnoid cyst, a ventriculocystocisternostomy is an important treatment option for BHDS arising from a suprasellar cyst. Three years after treatment, the head bobbing had resolved completely and psychomotor development was improving. Delay of diagnosis and treatment of this condition can cause permanent neurological dysfunction and psychomotor retardation. The authors recommend early ventriculocystocisternostomy as a physiologically based treatment for BHDS originating from a suprasellar cyst.