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Surgical Treatment of Suprasellar Arachnoid Cyst Dr. A. Barth, Neurochirurgische Klinik, Inselspital, CH-3010 Bern (Switzerland) Dear Sir, Suprasellar arachnoid cysts often present with hydrocephalus [1, 2]. Even if hydrocephalus can usually be treated without permanent shunting devices, the best surgical approach remains presently controversial concerning the operative risks and the avoidance of long-term recurrences [2]. We describe a case of suprasellar arachnoid cyst which was successfully treated by direct opening of the cyst wall and creation of a cis-ternocystostomy. A 34-year-old woman was admitted to our Department on February 12, 1991, with a 2-week history of increasing headaches, morning vomiting and tinnitus. Physical examination was normal. CT and MRI revealed a triventricular hydrocephalus caused by an expanding lesion located in the suprasellar region and extending backwards into the interpeduncular cistern (fig.l). The mass had a smooth external surface and intensity features similar to CSF. A right pterional craniotomy was performed to allow direct access to the lesion. Gross examination revealed a typical thick arachnoid membrane without evidence of neoplastic tissue. The arachnoid cyst was largely opened with outflow of CSF under pressure. To prevent recurrence of hydrocephalus, a free communication was created between the third ventricle and the basal subarachnoid space by resecting the lamina terminalis. A CT scan performed 18 months later confirmed the absence of cyst recurrence and normalization of the ventricle size.