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Vol. 12. Issue 6.
Pages 482-488 (January 2001)
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Vol. 12. Issue 6.
Pages 482-488 (January 2001)
Tratamiento endoscópico de los quistes aracnoideos supraselares
Endoscopic treatment of suprasellar arachnoid cysts
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J. Hinojosa, J. Esparza, M.J. Muñoz y, J. Valencia
Servicio de Neurocirugía Pediátrica. Hospital Universitario 12 de Octubre. Madrid
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Resumen

Los quistes aracnoideos representan tan sólo el 1% de todos los procesos expansivos intracraneales. En la población adulta los quistes aracnoideos supraselares suponen en torno al 9% del total, mientras que en la edad infantil dicha proporción alcanza el 15%. Pese a su frecuencia relativa en la práctica quirúrgica habitual quedan por resolver algunos aspectos relacionados con la patogénesis y evolución, historia natural y tratamiento.

La localización de esta patología en la cisterna supraselar y su íntima relación con el sistema ventricular la hacen especialmente susceptible de tratamiento endoscópico. El desarrollo de las técnicas de neuroendoscopia y la generalización en su empleo se han ido imponiendo a los abordajes microquirúrgicos clásicos como tratamiento de elección. Sin embargo existe controversia sobre el manejo de la hidrocefalia asociada, la necesidad de mantener una derivación quistoperitoneal tras el procedimiento endoscópico o la superioridad de la ventriculocistocisternostomía sobre la ventriculocistostomía.

Los autores presentan una serie consecutiva de siete pacientes con diagnostico “de novo” de quiste aracnoideo supraselar. El tratamiento consistió en cada uno de los casos en la fenestración endoscópica y extirpación de las membranas del quiste, con o sin ventriculostomía del suelo del III ventrículo asociada. En todos ellos mejoraron los síntomas preoperatorios y cinco permanecen libres de sistema de derivación peritoneal. En un paciente se mantiene una derivación quistoperitoneal mientras que otro, portador de una derivación ventrículoperitoneal previa a la intervención, continúa siendo válvulodependiente.

Se comentan la presentación clínica de los casos y evolución postoperatoria y se discuten las alternativas terapéuticas en el tratamiento endoscópico de los quistes supraselares.

Summary

Arachnoid cysts account for only 1% of all intracranial space-occupying lesions. In adults suprasellar cysts represent 9% of all the arachnoid cysts while in pediatric population this percentage reaches 15%. In spite of being a problem relatively common in daily neurosurgical practice there are still a number of questions to be solved concerning pathogenesis and evolution, natural history and treatment.

Located in the suprasellar cistern and closely related to the ventricular system, suprasellar arachnoid cysts conform a perfect indication for endoscopic treatment. The development and spreading of neuroendoscopic techniques have surpassed the standard microsurgical approaches as an elective treatment. However there is still controversy on the management of associated hydrocephalus, need for cystoperitoneal shunt after endoscopic fenestration or the superiority of ventriculocystocisternostomy over simple ventriculocystostomy.

The authors present a serie of seven consecutive patients with “de novo” diagnosis of suprasellar arachnoid cyst. In every case the treatment consisted in endoscopic fenestration and removal of the cyst membranes, with or without associated ventriculostomy of the Illrd ventricle. Preoperative symptoms improved in all the patients and five out of seven remain shunt free. One patient mantain a cystoperitoneal shunt and another one, previously shunted, remain shunt dependent.

The clinical presentation and postoperative evolution are commented with discussion on the alternative therapeutic options from the endoscopic point of view.

Key words:
Arachnoid cyst
Neuroendoscopy
Hydrocephalus

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