STEREOTAXIC CYSTO-VENTRICULAR SHUNTING IN DIENCEPHALIC (ARACHNOID) CYSTS AND FAILURE IN CYSTIC CRANIOPHARYNGEOMA

Stereotactic cysto-ventricular shunting in three patients with congeni tal (subependymal cyst of the 3rd ventricle, subependymal cyst of the foramen of Monro, cyst of cavum septi pellucidi) and in a female patie nt with a large cystic suprasellar craniopharyngeoma is dealt with in this paper. The first operation was performed in May 1992 and the late st, being considered in this paper, in October 1993. All patients were admitted to our hospital suffering from signs of increased intracrani al pressure. CT-scans revealed on the one hand an obstructive hydrocep halus subjected to the cystic arachnoid lesions, on the other hand a l arge hypodense suprasellar cystic tumor. After stereotactic puncture o f the arachnoid cysts, aspiration of their contents as well as biopsy of the wall, a silicone catheter was implanted, thus constructing a pe rmanent communication between the cyst and the lateral or third ventri cle. The internal catheter was connected to a subcutaneous burr-hole r eservoir. All these patients recovered uneventfully without neurologic al deficits. There were no operative complications. Follow-up CT-scans showed no recurrences of the cysts and obstructive hydrocephalus. In the patient with the suprasellar craniopharyngeoma at first a stereota ctic puncture of the cyst was performed. After recurrence the tumor wa s directly approached by an frontotemporal craniotomy. The histologica l examination revealed now a carinopharyngeoma. After renewed recurren ce a stereotactic cysto-ventriculostomy with internal shunt implantati on was performed. However, in this case this method was unsuccessful, documented by follow-up CT-scans. Resulting from our experiences, it i s quite obvious that the stereotactic internal shunt implantation seem s to be a safe, proper and reliable method in the treatment of arachno id cystic lesions. Open craniotomy or intracorporal shunting procedure s and their inherent complications can be avoided. It should, therefor e, be the aim of further clinical investigations to prove the value of this method in additional cases. However, in cystic craniopharyngeoma s this method does not seem to be the right choice of treatment.