ArticleJournal of neurosurgery. Case lessons2026
Technical nuances of endoscopic transcortical transventricular fenestration for management of giant suprasellar arachnoid cysts in adults: illustrative cases.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundArachnoid cysts (ACs) are collections of CSF within an arachnoid membrane. Suprasellar ACs (SACs) constitute 1%-9% of all ACs, with giant SACs representing a rarer subset at increased risk of rupture, intracranial hemorrhage, and neurological deficits. While ventriculostomy is well characterized, anatomical considerations and technical nuances of cystocisternostomy remain limited; adult presentation and outcomes remain poorly defined. The authors describe surgical technique and postoperative outcomes in 2 adult patients undergoing endoscopic ventriculocystocisternostomy for giant SACs. OBSERVATIONS: Both cases were managed with endoscopic transventricular ventriculocisternostomy. Intraoperatively, an absent tuber cinereum allowed for cyst wall fenestration under direct visualization. The first case was a 33-year-old male with bitemporal hemianopsia, headaches, and memory loss. He experienced significant improvement in his bitemporal hemianopsia and resolution of headaches at 1 year. The second case was a 36-year-old female with debilitating daily headaches, which decreased to one or two episodes per week at 5 months postoperatively. Follow-up imaging demonstrated decreased cyst size and mass effect. LESSONS: Giant ACs warrant closer surveillance and often surgery due to higher risks of deficits. Careful anatomical orientation and controlled dual fenestration are key to achieving durable decompression. Endoscopic ventriculocisternostomy is a feasible and effective approach for symptomatic SACs. https://thejns.org/doi/10.3171/CASE26372.
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