Neurosurgical Consultants: Downloads & Information Library: Arachnoid & Suprasellar Cysts

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Arachnoid & Suprasellar Cysts

Arachnoid Cysts are congenital lesions that arise during Brain and Skull development from a splitting of the arachnoid membrane, one of the covering layers of the Brain. This splitting results in the formation of a cyst.

Most Arachnoid Cysts become symptomatic in childhood. The exact symptoms depend upon the location of the cyst. These cysts can become quite large and yet only cause mild symptoms.

Typical symptoms include:

Headache
Nausea/vomiting
Lethargy
Seizures
Mass protrusion in the skull
Focal neurological signs secondary to pressure of surrounding structures
Developmental delay

Suprasellar Cysts (cysts laying above the "Sella Turcica" - which is the bone compartment at the base of the skull that houses the Pituitary Gland may have the following additional features:

Hydrocephalus due to obstruction of normal cerebrospinal fluid circulation
Endocrine symptoms occur in up to 60% of patients (such as early development of puberty)
Head bobbing
Visual impairment

Almost all Arachnoid Cysts occur in relation to an arachnoid cistern. The most common locations are the middle cranial fossa (near the temporal lobe) and suprasellar (near the third ventricle). However, cysts may be found anywhere within the intracranial compartment, including the posterior cranial fossa.

Routine evaluation with CT or MRI scan is usually satisfactory. CT scans usually show a smooth bordered cystic mass composed of a density similar to cerebrospinal fluid. There is no enhancement with contrast administration. Expansion of the nearby bone by remodeling is usually seen, confirming their chronic nature.

TREATMENT

Arachnoid cysts that do not cause significant mass effect or symptoms, regardless of their size and location, generally do not require treatment. If there is significant or severe mass effect on surrounding structures, or if there are symptoms, then surgical treatment is recommended. The following table summarizes the treatment options:

Procedure Advantages Disadvantages

Drainage by needle aspiration or burr hole drainage. Relatively simple and rapid technique. High rate of recurrence of the cyst and return of symptoms.

Craniotomy with excision of the cyst wall and fenestration of the cyst into normal communication with CSF pathways. Permits direct inspection of the cyst. Avoids permanent shunt in some cases. Allows visualization of vascular structures. Post-operative scarring may lead to a blockage of the fenestration leading to reaccumulation. More invasive.

Burr Hole Access for Endoscopic Fenestration of Cyst to Communicate into Normal CSF Pathways.
Shunting of the cyst.

Minimally Invasive Definitive Procedure.
Technically simplest procedure.

Technically more difficult. Procedure occasionally must be converted to an open craniotomy.
Patient becomes shunt dependent. High risk of shunt-related complication.

Arachnoid Cysts are an area of specific interest for the Neurosurgeons and staff of Neurosurgical Consultants. Their successful treatment in most cases involves the use, where applicable, of highly advanced Minimally Invasive Microsurgical Techniques. This revolutionary concept in Neurosurgery greatly limits the amount of surgical exposure required and therefore, limits the amount of tissue that is touched and retracted during the operation. Some procedures incorporate Endoscopic Techniques, which are conducted through very small holes in the skull. This results in less post-operative pain, earlier mobilization, diminished hospital stay, less risk for complications, an earlier return to activities as well as lower overall costs.