Endoscopic Laser Fenestration to Treat a Bobble-Head Doll Syndrome Caused by Suprasellar Cyst

Abstract The Bobble-Head Doll Syndrome (BHDS) is a rare acquired head movement disorder characterized by up and down or side-to-side movement most commonly seen in the first decade of life. The syndrome occurs more often in lesions causing third ventricle dilatation such as suprasellar or third ventricle cyst, but also it’s found in others pathologies associated with hydrocephalus like shunt dysfunctions, trapped fourth ventricle, congenital aqueductal stenosis, Dandy-Walker syndrome and cerebellar malformations. The pathophysiology of this head movement has different origins theories, one states that this stereotyped movements empties the cyst and move his dome away from the foramina of Monro, which relief the symptoms of hydrocephalus; the other suggest that the extrapyramidal tracts (rubrotegmentospinal and reticulospinal) are stimulated by the compression of dorsomedial nucleus of the thalamus by the cyst, those tracts innervate the neck muscles resulting in the bobbling head movements. This video (video 1) presents a clinical case of bobble head doll syndrome caused by suprasellar cyst in a 10 year old boy treated by endoscopic procedure. A ventriculo-cyst-cisternostmy was performed resulting in total improvement of the head movements and uneventful recovery. Postoperative images demonstrate decreasing of the cyst lesion and resolution of the hydrocephalus.