Technical Considerations to Prevent Postoperative Endocrine Dysfunction after the Fenestration of Suprasellar Arachnoid Cyst

OBJECTIVE: The endocrine dysfunction after the operation for suprasellar arachnoid cysts is not rare. The careful operation to prevent structures can prevent this complication, but it is not enough and effective to prevent it. Authors present technical surgical considerations to prevent this complication with a review of our suprasellar arachnoid cyst patients who had postoperative endocrine dysfunction. METHODS: From January 2002 to December 2009, eight patients who had suprasellar arachnoid cysts with visual impairment underwent surgery. The mean age was 57.1 years (range, 33-77). Preoperatively, their endocrine function was clinically normal, and laboratory hormonal levels were within normal ranges. Cyst fenestration was performed by craniotomy (n=6) or by a neuro-endoscopic procedure (n=2), and, simultaneously, along with a cyst wall biopsy. RESULTS: The surgery was uneventful in all eight patients, and there were no neurological morbidities. However, in four patients, endocrine dysfunction occurred postoperatively. We compared these four patients (group A) to the other 4 patients without endocrine dysfunction (group B) with intraoperative findings and with the histopathological findings of the cyst wall biopsy. The group A patients had more abundant vasculature on the cystic wall than the group B patients according to both the intraoperative findings and the histopathological findings. CONCLUSION: When performing a surgical cyst wall fenestration, surgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae.

A Case of Prenatal diagnosis and Postnatal Treatment of Suprasellar Arachnoid Cyst / 대한산부인과학회잡지

Arachnoid cysts represent 1 percent of all intracranial masses. Their common locations include the middle cranial fossa, the quadrigeminal cistern, the suprasellar region, the posterior fossa, and the region of the cerebral convexities. Midline cysts often create a disturbance in intracranial dynamics due to the shift and displacement of surrounding structures, and then developed hydrocephalus. So, early diagnosis and treatment of these cysts are important. The arachnoid cyst by ultrasonogram shows characteristic well capsulated homogeneous hypoechoic cyst. We report a case of prenatally diagnosed suprasellar arachnoid cyst by ultrasonogram and MRI, which was treated postnatally.

Failure of Shunt in Suprasellar Arachnoid Cyst: Case Report

We report a case of suprasellar arachnoid cyst with hydrocephalus which was diagnosed incidentally. This 41-year-old housewife had sympoms of hydrocephalus and hypophyseal dysfunction. Despite of well-functioning ventriculoperitioneal shunt and communication of the cyst with the ventricular system, the size of the ventricular system was never been normalized. She deteriorated progressively and eventually died shortly after the seventh operation. Unusual hospital couse is presented with brief review of the related literatures.

A Case of the Suprasellar Arachnoid Cyst

We report a case of the suprasellar arachnoid cyst with hydrocephalus which was incidental finding after minor head injury. Preoperatively, we studied the CT cisternography through lumbar route with niopam. It revealed that the arachnoid cyst was communicated with ventricles and delayed filling and clearance pattern of the cyst. The suprasellar arachnoid cyst with hydrocephalus was treated by combined craniotomy with partial removal of the membrane wall and cystoperioneal shunt. We reviewed the literature and discussed the diagnosis and treatment of the suprasellar arachnoid cyst.