We describe long-term outcomes of patients who underwent endoscopic fenestration and shrinkage fulguration of suprasellar arachnoid cysts (SACs) to effect immediate normalization of the ventricle floor.

     We refute the need for fenestrating the cyst floor (third ventriculostomy) when fenestrating the dome of the cyst with this technique.

     The subjects ranged from 4 months to 13 years and were followed post-operatively for 2 to 12 years (mean: 7 years). Five patients presented with macrocephaly, 4 patients with shunt malfunction.

     We performed a retrospective analysis of fourteen pediatric patients who underwent endoscopic fenestration, shrinkage coagulation of SACs. We reviewed immediate and late postoperative CT/MRI studies for reduction or resolution of the cyst, comparing pre- and post-operative volumes. We also investigated presenting symptoms (e.g. macrocephaly, headaches), growth velocity, BMI, endocrine profiles, and hydrocephalus/shunt histories.

     Cyst-size reduction was achieved in all subjects. In the 4 shunted patients, immediate postoperative imaging demonstrated on average 30% decrease in cyst size; and 45% decrease in the long-term. In the 10 patients without a shunt, there was an immediate 72% decrease in cyst size, and 97% decrease in the long-term. All patients without a shunt prior to the procedure remained shunt-free. Head circumference normalized to the 50th percentile in 4/5 patients presenting with macrocephaly. Re-fenestration was needed in 4 patients, whom were shunt-dependent prior to initial fenestration. None of the patients who were shunt-free required re-operation.

     This is a retrospective study.

     Endoscopic fenestration of the cyst dome and coagulation shrinkage of SACs prevents cyst recurrence.

     It also, represents a safe, effective therapeutic strategy.