Suprasellar Arachnoid Cysts: Toward a New Simple Classification Based on Prognosis and Treatment Modality. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: André, Arthur; Zérah, Michel; Roujeau, Thomas; Brunelle, Francis; Blauwblomme, Thomas; Puget, Stéphanie; Bourgeois, Marie; Sainte-Rose, Christian; Ville, Yves; Di Rocco, Federico
• Is Part Of: Neurosurgery. Volume 78:Issue 3(2016)
• Publication Date: 2016-03
• Subjects: Arachnoid cyst -- Basilar artery -- Cerebrospinal Fluid -- Endocrine system -- Hydrocephalus -- Prenatal diagnosis -- Ventriculostomy; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001049
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: Suprasellar arachnoid cysts (SAC) represent between 9% and 21% of pediatric arachnoid cysts. Recent improvements in magnetic resonance imaging, as well as increasing prenatal diagnosis, have allowed more precise knowledge and follow-up. OBJECTIVE: To describe a novel classification of SAC. METHODS: We present 35 cases of SAC treated between 1996 and 2014. Patient records and imaging studies were reviewed retrospectively to assess symptomatology, radiological findings, treatment, and long-term follow-up. RESULTS: Fourteen SAC were diagnosed prenatally (39%). We observed 15 (43%) cases presenting hydrocephalus (SAC-1) removing Liliequist membrane downward. Lower forms (SAC-2) with free third ventricle were observed in 11 (31%) cases. Asymmetrical forms (SAC-3) with Sylvian or temporal extension were seen in the 9 (26%) remaining patients. Twenty-three (66%) patients were treated by ventriculocisternostomy, 3 (8.5%) by shunt surgery, and 3 (8.5%) by craniotomy. Six (17%) patients had no surgery, including 5 cases (14%) that had prenatal diagnosis. Outcomes were initially favorable in 26 cases (87%). Eight (22%) patients had endocrine abnormalities at the end of the follow-up, 3 (8.5%) had developmental delay, and 6 (17%) had minor neuropsychological disturbances. CONCLUSION: SAC are heterogeneous entities. SAC-1 may come from an expansion of the diencephalic leaf of the Liliequist membrane. SAC-2 show a dilatation of the interpeduncular cistern and correspond to a defect of the mesencephalic leaf of the Liliequist membrane. SAC-3 correspond to the asymmetrical forms expanding to other subarachnoid spaces. Surgical treatment is not always necessary. The recognition of the different subtypes will allow choosing the best treatment option. ABBREVIATIONS: CSF, cerebrospinal fluid MRI, magnetic resonance imaging SAC, suprasellar arachnoid cysts VC, ventriculostomy VCC, ventriculocystocisternostomy Abstract : Supplemental Digital Content is Available in the Text.