SuprasellarArachnoid Cyst as a Cause of Triventricular Hydrocephalus, Found Incidentally During Endoscopic Third Ventriculostomy
Keywords:
Suprasellar arachnoid cyst, Triventricular hydrocephalus, Ventriculocisto-cisternotomyAbstract
Background: Arachniod cyst is a rare congenital disorder of the brain accounting 1% of all intracranial masses. They may also be acquired following head trauma, meningitis, tumors or surgery. They may be the cause of triventricular hydrocephalus (TVH). It occupies the third ventricle so flow of CSF is obstructed at aqueduct of Sylvius. Per operatively, it differs from colloid cyst in consistency, its capsule is transparent and blood vessels are visible.
Objectives: To determine the frequency of suprasellar arachnoid cyst as cause of triventricular hydrocephalus and outcome of ventriculocystocisternotomy performed for these cysts at Lady Reading Hospital, Peshawar.
Materials and Methods: A retrospective study of 18 cases who undergone ETV for congenital TVH from January, 2013 to December 2015 at Neurosurgery department LRH was performed. On pre operative CT scan brain they were having triventricular hydrocephalus. Ventriculocysto-cisternotomy was performed in all these cases. Biopsy was taken in all cases.
Results: Out of these 18 cases, 11 (61%) were males. The presenting symptoms in our study were that infants presented with increased head circumference (n = 3) 16.6%. In pediatric and middle age group the symptoms were those of elevated ICP (n = 13) 72.22%. No endoscopic complication occurred during the procedure except for clinically non-significant bleeds. We followed all cases for a period of 6 months. Clinical and radiological improvement occurred in all cases.
Conclusion: Arachnoid cyst should also be considered as a differential for congenital TVH. Endoscopic Ventriculocystocisternotomy is the treatment option of choice forsuprasellararachnoid cyst.
Abbreviations: TVH: Triventricular Hydrocephalus. CSF: Cerebral Scleral Fluid. ICP: Intracranial Pressure. AC: Arachnoid Cyst. SSCs: Suprasellar arachnoid cysts. VC: Ventriculocystostomy. VCC: Ventriculocystocisternotomy. CT: Computer Tomography.
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