Abstract
To investigate the effectiveness of endoscopic fenestration in the patients with prior failed ventriculoperitoneal (VP) shunt treatment of suprasellar arachnoid cysts (SACs). Between 2012 and 2018, four pediatric patients of SACs with previous failed VP shunt treatment were surgically treated using endoscopic ventriculocystocisternostomy (VCC) in our hospital. The clinical symptoms, imaging data, and surgical outcomes were collected and analyzed retrospectively. A literature review is provided with regard to the reasons of shunt failure and surgical outcome of further endoscopic fenestration in the previously reported patients of SACs with prior failed VP shunt. For the 4 cases, the initial clinical symptoms relieved or even disappeared after shunt placement, but, respectively, recurred 2, 6, 11, and 6 months later. MR scans were conducted when the clinical symptoms reappeared and showed a cyst had greatly enlarged after shunt placement. Furthermore, VP shunt-related slit ventricle was also demonstrated in 3 cases. Clinical improvement and cysts shrinkage occurred in all 4 patients after VCC. Slit ventricle and hydrocephalus were also resolved. Three patients had their shunt apparatus removed after VCC, and another patient’s guardian refused to remove the shunt apparatus. Subdural hematoma occurred in one case after shunt apparatus removal. Four patients have been stable during follow-up period (mean follow-up 26.5 months). All the three patients whose VP shunt were removed were shunt independence. There were 24 patients who underwent endoscopic fenestration as an alternative to the failed VP shunt treatment in the published reports. Added our 4 patients to the published group, the effective rate of endoscopic fenestration for SACs following previous failed VP shunt treatment was approximately 93% (26/28). Of the 24 patients, the shunt apparatuses were in situ or reimplantation in 9 patients due to shunt dependence. The correction to recognize the SAC is the first condition to select the optimal management philosophy. The analysis of the series suggests endoscopic operation is still an effective and safe option in the SAC patients with previous failed VP shunt, and the shunt apparatus can be removed for some patients. The short interval time between shunt operation and endoscopic fenestration is conductive to return patients to the shunt-free state.
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References
Crimmins DW, Pierre-Kahn A, Sainte-Rose C, Zerah M (2006) Treatment of suprasellar cysts and patient outcome. J Neurosurg 105:107–114. https://doi.org/10.3171/ped.2006.105.2.107
Rengachary SS, Watanabe I (1981) Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61–83
Gui SB, Wang XS, Zong XY, Zhang YZ, Li CZ (2011) Suprasellar cysts: clinical presentation, surgical indications, and optimal surgical treatment. BMC Neurol 11:52. https://doi.org/10.1186/1471-2377-11-52
Gui SB, Yu SY, Cao L, Bai JW, Wang XS, Li CZ, Zhang YZ (2016) Endoscopic treatment of suprasellar cysts without hydrocephalus. J Neurosurg Pediatr 18:434–441. https://doi.org/10.3171/2016.4.Peds15695
Caemaert J, Abdullah J, Calliauw L, Carton D, Dhooge C, van Coster R (1992) Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir 119:68–73
Rappaport ZH (1993) Suprasellar arachnoid cysts: options in operative management. Acta Neurochir 122:71–75
Gangemi M, Colella G, Magro F, Maiuri F (2007) Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 21:276–280. https://doi.org/10.1080/02688690701339197
Wang JC, Heier L, Souweidane MM (2004) Advances in the endoscopic management of suprasellar arachnoid cysts in children. J Neurosurg 100:418–426. https://doi.org/10.3171/ped.2004.100.5.0418
Kim SK, Cho BK, Chung YN, Kim HS, Wang KC (2002) Shunt dependency in shunted arachnoid cyst: a reason to avoid shunting. Pediatr Neurosurg 37:178–185. https://doi.org/10.1159/000065393
Sood S, Schuhmann MU, Cakan N, Ham SD (2005) Endoscopic fenestration and coagulation shrinkage of suprasellar arachnoid cysts. Technical note. J Neurosurg 102:127–133. https://doi.org/10.3171/ped.2005.102.1.0127
Kojder K (2015) Clinical and radiological characteristics of the cyst of the septum pellucidum in endoscopically treated patients. Pomeranian J Life Sci 61:12–33
Fitzpatrick MO, Barlow P (2001) Endoscopic treatment of prepontine arachnoid cysts. Br J Neurosurg 15:234–238
Fioravanti A, Godano U, Consales A, Mascari C, Calbucci F (2004) Bobble-head doll syndrome due to a suprasellar arachnoid cyst: endoscopic treatment in two cases. Childs Nerv Syst 20:770–773. https://doi.org/10.1007/s00381-004-0925-3
Charalampaki P, Filippi R, Welschehold S, Conrad J (2005) Endoscopic and endoscope-assisted neurosurgical treatment of suprasellar arachnoidal cysts (Mickey Mouse cysts). Minim Invasive Neurosurg 48:283–288. https://doi.org/10.1055/s-2005-870953
Struck AF, Murphy MJ, Iskandar BJ (2006) Spontaneous development of a de novo suprasellar arachnoid cyst. Case report. J Neurosurg 104:426–428. https://doi.org/10.3171/ped.2006.104.6.426
Ersahin Y, Kesikci H, Ruksen M, Aydin C, Mutluer S (2008) Endoscopic treatment of suprasellar arachnoid cysts. Childs Nerv Syst 24:1013–1020. https://doi.org/10.1007/s00381-008-0615-7
Ogiwara H, Morota N, Joko M, Hirota K (2011) Endoscopic fenestrations for suprasellar arachnoid cysts. J Neurosurg Pediatr 8:484–488. https://doi.org/10.3171/2011.8.Peds11226
Zheng J, Chen G, Xiao Q, Huang Y, Guo Y (2017) Endoscopy in the treatment of slit ventricle syndrome. Exp Ther Med 14:3381–3386. https://doi.org/10.3892/etm.2017.4973
Maher CO, Goumnerova L (2011) The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts. J Neurosurg Pediatr 7:64–72. https://doi.org/10.3171/2010.10.Peds10356
Krawchenko J, Collins GH (1979) Pathology of an arachnoid cyst. Case report. J Neurosurg 50:224–228. https://doi.org/10.3171/jns.1979.50.2.0224
Binitie O, Williams B, Case CP (1984) A suprasellar subarachnoid pouch; aetiological considerations. J Neurol Neurosurg Psychiatry 47:1066–1074. https://doi.org/10.1136/jnnp.47.10.1066
Kirollos RW, Javadpour M, May P, Mallucci C (2001) Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718. https://doi.org/10.1007/s003810100494
Mangussi-Gomes J, Gentil AF, Filippi RZ, Momesso RA, Handfas BW, Radvany J, Balsalobre L, Stamm AC (2019) Sellar and suprasellar arachnoid cyst. Einstein (Sao Paulo) 17:eAI4269. https://doi.org/10.31744/einstein_journal/2019AI4269
Ramesh S, Raju S (2015) Suprasellar arachnoid cyst presenting with bobble-head doll syndrome: report of three cases. J Pediatr Neurosci 10:18–21. https://doi.org/10.4103/1817-1745.154321
Rao K, Levy ML, Crawford JR (2014) Giant suprasellar arachnoid cyst presenting with precocious puberty. BMJ Case Rep 2014:bcr2014205750. https://doi.org/10.1136/bcr-2014-205750
Starkman SP, Brown TC, Linell EA (1958) Cerebral arachnoid cysts. J Neuropathol Exp Neurol 17:484–500. https://doi.org/10.1097/00005072-195807000-00009
Fox JL, Al-Mefty O (1980) Suprasellar arachnoid cysts: an extension of the membrane of Liliequist. Neurosurgery 7:615–618. https://doi.org/10.1227/00006123-198012000-00016
Zhang M, An PC (2000) Liliequist’s membrane is a fold of the arachnoid mater: study using sheet plastination and scanning electron microscopy. Neurosurgery 47:902–908; discussion 908-909. https://doi.org/10.1097/00006123-200010000-00021
Golash A, Mitchell G, Mallucci C, May P, Pilling D (2001) Prenatal diagnosis of suprasellar arachnoid cyst and postnatal endoscopic treatment. Childs Nerv Syst 17:739–742. https://doi.org/10.1007/s003810100467
Decq P, Brugieres P, Le Guerinel C, Djindjian M, Keravel Y, Nguyen JP (1996) Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696–701. https://doi.org/10.3171/jns.1996.84.4.0696
Nakamura Y, Mizukawa K, Yamamoto K, Nagashima T (2001) Endoscopic treatment for a huge neonatal prepontine-suprasellar arachnoid cyst: a case report. Pediatr Neurosurg 35:220–224. https://doi.org/10.1159/000050425
Boutarbouch M, El Ouahabi A, Rifi L, Arkha Y, Derraz S, El Khamlichi A (2008) Management of intracranial arachnoid cysts: institutional experience with initial 32 cases and review of the literature. Clin Neurol Neurosurg 110:1–7. https://doi.org/10.1016/j.clineuro.2007.08.009
Li C, Yin L, Jiang T, Ma Z, Jia G (2014) Shunt dependency syndrome after cystoperitoneal shunting of arachnoid cysts. Childs Nerv Syst 30:471–476. https://doi.org/10.1007/s00381-013-2248-8
Hayes MJ, TerMaath SC, Crook TR, Killeffer JA (2019) A review on the effectiveness of surgical intervention for symptomatic intracranial arachnoid cysts in adults. World Neurosurg 123:e259–e272. https://doi.org/10.1016/j.wneu.2018.11.149
Ozek MM, Urgun K (2013) Neuroendoscopic management of suprasellar arachnoid cysts. World Neurosurg 79:S19.e13–S19.e18. https://doi.org/10.1016/j.wneu.2012.02.011
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Ma, GF., Li, CZ., Zhang, YZ. et al. A good choice for the patients with prior failed ventriculoperitoneal shunt treatment of suprasellar arachnoid cysts: endoscopic fenestration. Neurosurg Rev 43, 1373–1381 (2020). https://doi.org/10.1007/s10143-019-01152-x
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DOI: https://doi.org/10.1007/s10143-019-01152-x