Different Neuroendoscopic Modalities for Management of Suprasellar Arachnoid Cysts: Comparative Study

Abstract

BACKGROUND: Arachnoid cysts account for approximately 1% of all intracranial mass lesions, with suprasellar arachnoid cysts (SACs) representing a rare subset. Hydrocephalus is the most common presentation, occurring in nearly 90% of the cases. Due to their rarity, no universal consensus exists regarding classification, optimal surgical management, or outcome assessment. OBJECTIVE: To compare outcomes of ventriculocystostomy (VC) and ventriculocystocisternostomy (VCC) in the endoscopic management of suprasellar arachnoid cysts. METHODS: This retrospective study reviewed patients with SACs who underwent endoscopic fenestration at a tertiary referral center between February 2015 and June 2025. Seventeen patients (9 males, 8 females; age range: 4-60 years), in the study, all presenting with hydrocephalus, were included. Endoscopic procedures were performed using rigid neuroendoscopy via either VC or VCC. Pre- and postoperative clinical and magnetic resonance imaging data were analyzed. Follow-up ranged from 6 to 30 months (mean: 24 months). The primary outcome was procedural success, defined as sustained clinical improvement accompanied by radiological reduction in cyst size or ventricular dilatation without need for additional surgical intervention. RESULTS: Eight patients underwent VC and 9 underwent VCC. Overall success was achieved in 15 patients (88%), with success rates of 86% for VC and 89% for VCC. Two patients required subsequent ventriculoperitoneal shunt placement. Postoperative complications included cerebrospinal fluid leakage in one patient and transient diabetes insipidus in one patient. CONCLUSIONS: Endoscopic fenestration is a safe and effective first-line treatment for suprasellar arachnoid cysts using either VC or VCC, with surgery reserved for symptomatic patients or those with hydrocephalus.