Endoscopic treatment of prepontine arachnoid cysts

Prepontine (or suprasellar) arachnoid cysts are uncommon in clinical practi ce and experience in their management may therefore be limited. Symptomatic cysts usually present with features of hydrocephalus due to obstruction of the third ventricle and aqueduct, and occlusion or partial obstruction of both foramina of Monro. Several treatment techniques have been used includi ng stereotactic aspiration, microsurgical excision and shunting, but the be st method of treatment remains unclear and the role of endoscopy is not yet established. We report our experience in a series of seven patients who ha d endoscopic treatment for prepontine arachnoid cysts; five were children u nder 15 years old who presented with delayed development and/or enlarged he ads. The two adult patients, both of whom had insertion of shunts as childr en, presented with headache and vomiting due to shunt blockage. All patient s improved following endoscopic cyst fenestration. There was no operative m orbidity and there have been no relapses to date. Endoscopic fenestration o f prepontine arachnoid cysts appears to be an effective method of treatment .