Hypothalamic dysfunction from a third ventricular arachnoid cyst presenting as central precocious puberty: Endoscopic management and clinical outcome

Arachnoid cysts of the third ventricle are rare benign cerebrospinal fluid lesions that may become symptomatic through obstruction of cerebrospinal fluid pathways and compression of hypothalamic-pituitary structures. Central precocious puberty represents an uncommon mode of presentation. We re port the case of a 5-year-old boy referred for progressive precocious puberty associated with accelerated growth and pubertal development. Endocrinological evaluation confirmed central precocious puberty, while brain magnetic resonance imaging revealed a large third ventricular arachnoid cyst associated with severe obstructive hydrocephalus. The patient underwent successful neuroendoscopic ventriculocystocisternostomy with an uneventful postoperative course. This case highlights the importance of considering intracranial lesions in the evaluation of central precocious puberty and supports neuroendoscopic ventriculocystocisternostomy as a safe and effective minimally invasive treatment for symptomatic third ventricular arachnoid cysts.