Suprasellar arachnoid cyst with temporal extension or temporal cyst with suprasellar extension?

Authors

  • Aldo José F da Silva Pediatric Neurosurgery, General State Hospital and at the Pediatric Neurosurgery Division of the Santa Mônica Teaching Maternity - Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil https://orcid.org/0000-0002-5520-1921

DOI:

https://doi.org/10.46900/apn.v4i3(September-December).150

Keywords:

headache, arachnoid cyst, supra selar, hydrocephalus, ventriculoperitoneal shunt

Abstract

A 4-year-old female child presented to an emergency hospital with headache and episodes of seizures. Computed tomography and magnetic resonance imaging of the skull (Figs. 1a, b and c) were performed; they showed large suprasellar cystic lesions with right temporal extension and mild hydrocephalus. Subsequently, an endoscopic ventriculocystocysternotomy was performed (Figs. 1d, e, and f), which showed good results.

Suprasellar arachnoid cysts account for 9%–21% of the pediatric arachnoid cysts [1,2]. According to the morphology and characteristics, there are three types of suprasellar arachnoid cysts, as follows: 1. Diencephalic leaflet dilatation of the Liliequist membrane with the formation of purely suprasellar cysts, which presents with hydrocephalus; 2. The defect of the mesencephalic leaflet of the Liliequist membrane with dilatation of the interpeduncular cistern, which presents without hydrocephalus; 3. Asymmetrical form that extends to other subarachnoid spaces, which presents with macrocrania and mild or no hydrocephalus [1], similar to the present case. The expansion could be due to an osmotic gradient, a slit valve mechanism, tissue debris transudation from the choroid plexus, or ectopic glial cells [3]. The first treatment option for suprasellar arachnoid cysts should be endoscopic ventriculocystocysternotomy; ventriculoperitoneal shunt may be considered the second treatment option if endoscopic ventriculocystocysternotomy fails [2].

 

Figure Caption

Magnetic resonance imaging of the brain: (a) T1 axial and (b) T2 axial showing a large suprasellar (black arrows) cyst with expansion to the right temporal pole, having a mass effect and mild ventricular dilatation(white arrows) without ependymal transudation; (c) Sagittal FIESTA-T2 with compressive effect on the brain stem(white arrow) and basilar artery(black arrow) displacement; Endoscopic view: (d) ventriculocystotomy; (e) the third ventricular floor with pituitary stalk(black arrow) and gland(white arrow), dorsum of the sella turcica(black curved arrow), posterior communicating artery(black arrowhead), and oculomotor nerve(white arrowhead); (f) cyststocisternotomy was conducted with visualization of the basilar artery((black arrow) and dorsum of the saddle.

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References

André A, Zérah M, Roujeau T, Brunelle F, Blauwblomme T, Puget S, et al. Suprasellar arachnoid cysts: a new simple classification based on prognosis and treatment modality. Neurosurgery. 2016;78(3):370-9.

Gui SB, Wang XS, Zong XY, Zhang YZ, Li CZ. Suprasellar cysts: clinical presentation, surgical indications, and optimal surgical treatment. BMC Neurology. 2011;11(1):52.

Ma G, Li X, Qiao N, Zhang B, Li C, Zhang Y, et al. Suprasellar arachnoid cysts in adults: clinical presentations, radiological features, and treatment outcomes. Neurosurgical Review. 2021;44(3):1645-53.

Additional Files

Published

2022-06-08

How to Cite

1.
da Silva AJF. Suprasellar arachnoid cyst with temporal extension or temporal cyst with suprasellar extension?. Arch Pediatr Neurosurg [Internet]. 2022 Jun. 8 [cited 2024 May 24];4(3(September-December):e1502022. Available from: https://archpedneurosurg.com.br/sbnped2019/article/view/150