• Arthur André, Michel Zérah, Thomas Roujeau, Francis Brunelle, Thomas Blauwblomme, Stéphanie Puget, Marie Bourgeois, Christian Sainte-Rose, Yves Ville, and Federico Di Rocco.
• *Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris, France; ‡Department of Neuroradiology Necker Enfants Malades Hospital, APHP, Paris, France; §Department of Obstetrics Necker Enfants Malades Hospital, APHP, Paris, France.
• Neurosurgery. 2016 Mar 1; 78 (3): 370-9; discussion 379-80.

BackgroundSuprasellar arachnoid cysts (SAC) represent between 9% and 21% of pediatric arachnoid cysts. Recent improvements in magnetic resonance imaging, as well as increasing prenatal diagnosis, have allowed more precise knowledge and follow-up.ObjectiveTo describe a novel classification of SAC.MethodsWe present 35 cases of SAC treated between 1996 and 2014. Patient records and imaging studies were reviewed retrospectively to assess symptomatology, radiological findings, treatment, and long-term follow-up.ResultsFourteen SAC were diagnosed prenatally (39%). We observed 15 (43%) cases presenting hydrocephalus (SAC-1) removing Liliequist membrane downward. Lower forms (SAC-2) with free third ventricle were observed in 11 (31%) cases. Asymmetrical forms (SAC-3) with Sylvian or temporal extension were seen in the 9 (26%) remaining patients. Twenty-three (66%) patients were treated by ventriculocisternostomy, 3 (8.5%) by shunt surgery, and 3 (8.5%) by craniotomy. Six (17%) patients had no surgery, including 5 cases (14%) that had prenatal diagnosis. Outcomes were initially favorable in 26 cases (87%). Eight (22%) patients had endocrine abnormalities at the end of the follow-up, 3 (8.5%) had developmental delay, and 6 (17%) had minor neuropsychological disturbances.ConclusionSAC are heterogeneous entities. SAC-1 may come from an expansion of the diencephalic leaf of the Liliequist membrane. SAC-2 show a dilatation of the interpeduncular cistern and correspond to a defect of the mesencephalic leaf of the Liliequist membrane. SAC-3 correspond to the asymmetrical forms expanding to other subarachnoid spaces. Surgical treatment is not always necessary. The recognition of the different subtypes will allow choosing the best treatment option.

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