Suprasellar arachnoid cyst

My 10month old infant son has been diagnosed with obstructive hydrocephalus secondary to a suprasellar arachnoid cyst.  Despite the large size of the cyst and degree of the hydrocephaly, he is relatively asymptomatic.  He has some minor gross motor developmental delays and his left eye has deviated outward more and more as the condition advanced.  A team of neurosurgeons plan to perform an endoscopic fenestration of the cyst and insert a VP shunt.  The VP shunt, we are told, is advisable due to his age and the need to ensure more rapid CSF drainage than can be assured through fenestration alone.  Is a shunt necessary?  We are also concerned with the left eye deviation and have been told that neurology or ophthalmology will be consulted if the condition does not resolve within a couple of weeks after surgery.  Is this appropriate or might there be value in involving others at an earlier stage?  We wonder if there are rehabilitative measures that might be more effective if begun sooner.

[Dr. A. Srivastava]

Thank you for your question. Although without being able to examine you I can not offer you the specific advice on diagnosis and treatment that you need, but I would try to provide you some relevant information about your health concern.

Arachnoid cyst is a brain cyst that may remain asymptomatic for long years. But if it is large it can cause headache, paralysis, seizures and gait disorders. Therefore, surgical intervention is essential to remove the large cyst and if permanent damage needs to be avoided.  Craniotomy, needle aspiration and cerebral shunts are common surgical treatment that may help.  Please consult a neurologist right away in this regard. Hope this helps.