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

Stereotactic cysto-ventricular shunting in three patients with congenital (subependymal cyst of the 3rd ventricle, subependymal cyst of the foramen of Monro, cyst of cavum septi pellucidi) and in a female patient with a large cystic suprasellar craniopharyngeoma is dealt with in this paper. The first operation was performed in May 1992 and the latest, being considered in this paper, in October 1993. All patients were admitted to our hospital suffering from signs of increased intracranial pressure. CT-scans revealed on the one hand an obstructive hydrocephalus subjected to the cystic arachnoid lesions, on the other hand a large hypodense suprasellar cystic tumor. After stereotactic puncture of the arachnoid cysts, aspiration of their contents as well as biopsy of the wall, a silicone catheter was implanted, thus constructing a permanent communication between the cyst and the lateral or third ventricle. The internal catheter was connected to a subcutaneous burr-hole reservoir. All these patients recovered uneventfully without neurological 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 stereotactic puncture of the cyst was performed. After recurrence the tumor was directly approached by an frontotemporal craniotomy. The histological examination revealed now a carinopharyngeoma. After renewed recurrence a stereotactic cysto-ventriculostomy with internal shunt implantation was performed. However, in this case this method was unsuccessful, documented by follow-up CT-scans. Resulting from our experiences, it is quite obvious that the stereotactic internal shunt implantation seems to be a safe, proper and reliable method in the treatment of arachnoid cystic lesions. Open craniotomy or intracorporal shunting procedures and their inherent complications can be avoided. It should, therefore, be the aim of further clinical investigations to prove the value of this method in additional cases. However, in cystic craniopharyngeomas this method does not seem to be the right choice of treatment.