Bobble-head doll syndrome due to a suprasellar archnoid cyst: Endoscopic treatment in two cases

Object: We report two cases of bobble-head doll syndrome associated with a large suprasellar arachnoid cyst successfully treated with a minimally invasive endoscopic approach. Methods: The clinical history, surgical treatment and results of two children, a 9-year-old boy and a 1-year-old girl, both presenting the clinical features of the bobble-head doll syndrome, are described. As a first procedure, a ventriculo-cystostomy was endoscopically performed in both patients, obtaining either resolution of the symptoms or notable cyst reduction. In the girl, a re-closure of the stoma, with cyst re-expansion, was observed after 18 months. She then underwent a second procedure, a ventriculo-cysto-cisternostomy, with a good result. After 3 years' follow-up, the neurological condition of both patients remains good with complete resolution of abnormal head movement. Conclusion: In our opinion, endoscopic treatment is the procedure of choice for this condition, as it involves few complications and gives good results.