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Silva J, Bornancin GX, Ramina R. A Rare Case of an Intrasellar Arachnoid Cyst With Middle Cranial Fossa Extension. Cureus 2023; 15:e41022. [PMID: 37519516 PMCID: PMC10372851 DOI: 10.7759/cureus.41022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Intrasellar arachnoid cysts represent around 1% of all selar lesions. Generally, patients are asymptomatic and when they exhibit visual and/or hormonal disturbances, the indication for surgery is prompted. A 51-year-old woman with a known purely intrasellar arachnoid cyst diagnosed 23 years prior to presentation, evolved with gradual campimetric evaluation. Magnetic resonance imaging showed significant growth of the lesion, now extending into the left middle fossa through the cavernous sinus. The patient underwent cyst fenestration via the transsphenoidal approach. This is the first case in the literature of a patient with an intrasellar arachnoid cyst extending into the middle cranial fossa.
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Affiliation(s)
- Joseph Silva
- Neurosurgery, Neurological Institute of Curitiba, Curitiba, BRA
| | | | - Ricardo Ramina
- Neurological Surgery, Instituto Neurológico de Curitiba, Curitiba, BRA
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Matmusaev M, Watanabe T, Iwami K, Akhmediev T. Endoscopic transnasal transsphenoidal management of sellar/suprasellar arachnoid cyst: A case report and literature review. Surg Neurol Int 2023; 14:131. [PMID: 37151455 PMCID: PMC10159303 DOI: 10.25259/sni_1102_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Background Arachnoid cysts (ACs) are collections of cerebrospinal fluids (CSFs) that develop within the arachnoid layer of the meninges. Sellar ACs are comparatively rare. In general, ACs account for approximately 1% of all intracranial mass lesions, and sellar ACs are 3% of all intracranial ACs. An endoscopic transnasal transsphenoidal approach for the treatment of ACs by fenestrating the cyst's wall and connecting with the subarachnoid space is the most optimal option. Case Description A 74-year-old woman whose sellar AC was diagnosed on magnetic resonance imaging a year ago was admitted to our hospital with complaints of bitemporal hemianopia and diminished visual acuity in the past 2 months. Sellar AC was diagnosed based on the clinical history and presentation, as well as neurologic, endocrinologic, and ophthalmologic examinations, including visual acuity and visual field examination, and additional imaging findings. The patient with a sellar/suprasellar AC was treated by an endoscopic transnasal transsphenoidal approach with cyst drainage and perforation of the lamina terminalis. Postoperatively, the visual disturbances improved markedly. No surgery-related complications occurred. Conclusion The endoscopic transnasal transsphenoidal approach remains a minimally invasive and preferred approach for the treatment of sellar/suprasellar ACs. Hermetically reconstructing the sellar floor is an effective method to prevent CSF leakage.
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Affiliation(s)
- Maruf Matmusaev
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Skull Base Surgery, Republican Specialized Scientific Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
- Corresponding author: Maruf Matmusaev, Department of Skull Base Surgery, Republican Specialized Scientific Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan.
| | - Tadashi Watanabe
- Department of Neurosurgery, Aichi Medical University, Nagoya, Japan
| | - Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, Nagoya, Japan
| | - Tokhir Akhmediev
- Department of Neurosurgery, Tashkent Medical Academy, Tashkent, Uzbekistan
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Gadelha MR, Wildemberg LE, Lamback EB, Barbosa MA, Kasuki L, Ventura N. Approach to the Patient: Differential Diagnosis of Cystic Sellar Lesions. J Clin Endocrinol Metab 2022; 107:1751-1758. [PMID: 35092687 DOI: 10.1210/clinem/dgac033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 02/13/2023]
Abstract
Cystic lesions arising in the sellar region are not uncommon and encompass cystic pituitary adenomas, Rathke cleft cysts, craniopharyngiomas, and arachnoid cysts. Their clinical presentation may be similar, including headache, visual field defects, and anterior pituitary hormone deficits, which makes differential diagnosis challenging. On the other hand, imaging features may indicate certain pathologies. In this approach to the patient, we describe the case of a patient who presented with right temporal hemianopsia and a sellar/suprasellar cystic lesion, which was determined to be Rathke cleft cyst. We discuss the imaging characteristics that may suggest a particular diagnosis between Rathke cleft cyst, cystic pituitary adenoma, craniopharyngioma, and arachnoid cyst and propose a flowchart for aiding in the imaging differential diagnosis.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Luiz Eduardo Wildemberg
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Elisa Baranski Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Monique Alvares Barbosa
- Radiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Radiology Unit, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil
- MRI Unit, Clínica de Diagnóstico por imagem, DASA, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Nina Ventura
- Radiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroradiology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroradiology Unit, Samaritano Hospital, Grupo Fleury, Rio de Janeiro, Brazil
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Kalyvas A, Milesi M, Leite M, Yang K, Jacques LS, Vescan A, Mete O, Ezzat S, Zadeh G, Gentili F. Endoscopic treatment of sellar arachnoid cysts via a simple cyst-opening technique: Long-term outcomes from a single center. World Neurosurg 2022; 161:e625-e634. [PMID: 35217229 DOI: 10.1016/j.wneu.2022.02.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sellar arachnoid cysts (SACs) are rare lesions that require treatment only if symptomatic. The endoscopic endonasal approach has been widely utilized. Despite their simple cystic appearance and the straight-forward surgical intervention there are important associated risks, with CSF leak being the prevalent one. METHODS A retrospective analysis of patients with pathologically confirmed SAC between January 2006 and December 2019 was conducted. A homogeneous simple cyst-opening technique and skull base reconstruction utilizing nasoseptal flaps was used. RESULTS Ten patients were identified (7 female and 3 male, median age was 54.5 years, range 20-77); 8 had newly diagnosed SACs whereas 2 recurrences from a previously microsurgically fenestrated SAC. Eight patients presented with visual symptoms (VS), 1 with VS and fatigue, and 1 with headaches. Neuro-ophthalmological and endocrinological assessments revealed visual field (VF) deficits in 6, visual acuity (VA) decline in 5 and hypopituitarism in 2 patients. Median calculated volume was 1.71 ml (range 0.27 - 2.54 ml). Postoperatively, no CSF leak and no further surgical complications were noted. VF improved in 4/6 while VA improved in 4/5 patients. Anterior pituitary function improved in 1, worsened in 1 and remained stable in 8 patients. One patient suffered diabetes insipidus. One recurrence was recorded 54 months postoperatively. CONCLUSION SACs can be effectively treated with a simple cyst-opening technique. The routine use of nasoseptal flaps significantly reduces the risk of CSF leak without compromising nasal quality of life in the long-term or mandating additional incisions. A long-term follow-up is important to monitor for late recurrences.
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Affiliation(s)
- Aristotelis Kalyvas
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Matthias Milesi
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Matheus Leite
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Kaiyun Yang
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Leslie St Jacques
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Allan Vescan
- Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shereen Ezzat
- Department of Endocrine Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Fred Gentili
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Sasaki N, Tani S, Funakoshi Y, Imamura H, Fukumitsu R, Sakai N. Endoscopic management of an intrasellar arachnoid cyst through the tuber cinereum in an adult: a case report. Acta Neurochir (Wien) 2020; 162:2397-2401. [PMID: 32445123 DOI: 10.1007/s00701-020-04409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/10/2020] [Indexed: 11/26/2022]
Abstract
The transventricular endoscopic approach is an effective less invasive method for the management of symptomatic intrasellar arachnoid cysts in adults. The open area of the brain tissue defect in the infundibular recess caused by the upward compression of the cyst is a common target site for fenestration from the third ventricle. This report highlighted an alternative approach through the tuber cinereum (denoted as "trans-tuberal"), which enabled the treatment of symptomatic cases with a small opening for cyst fenestration in the infundibular recess.
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Affiliation(s)
- Natsuhi Sasaki
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Yusuke Funakoshi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Ryu Fukumitsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
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Mbaye M, Sylla N, Thioub M, Sy ECN, Faye M, Thiam AB, Ba MC, Badiane SB. [Update on intrasellar arachnoid cyst: a case study]. Pan Afr Med J 2019; 34:55. [PMID: 31762921 PMCID: PMC6859025 DOI: 10.11604/pamj.2019.34.55.18564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/24/2019] [Indexed: 11/30/2022] Open
Abstract
Les kystes arachnoïdiens intrasellaires sont des malformations bénignes. La localisation intrasellaire est extrêmement rare de l’ordre de 3%. Leur physiopathologie est encore mal élucidée. Nous rapportons un cas de kyste arachnoïdien intrasellaire à expansion suprasellaire dont la prise en charge avait consisté en une fenestration endoscopique par voie transsphénoïdale. Les aspects épidémiologiques, cliniques, physiopathologiques, radiologiques, thérapeutiques et évolutifs ont été analysés. Les procédures neuroendoscopiques sont de plus en plus utilisées pour la prise en charge chirurgicale. Leur pronostic est bon, et la récidive fréquente même après plusieurs années d’évolution.
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Affiliation(s)
- Maguette Mbaye
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Nfamara Sylla
- Service de Neurochirurgie, Hôpital Général de Grand Yoff, Dakar, Sénégal
| | - Mbaye Thioub
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Elhadj Cheikh Ndiaye Sy
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Mohameth Faye
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Alioune Badara Thiam
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Momar Code Ba
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Seydou Boubakar Badiane
- Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
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Ovenden CD, Almeida JP, Oswari S, Gentili F. Pituitary abscess following endoscopic endonasal drainage of a suprasellar arachnoid cyst: Case report and review of the literature. J Clin Neurosci 2019; 68:322-328. [PMID: 31402262 DOI: 10.1016/j.jocn.2019.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/27/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Arachnoid cysts are uncommon lesions of the sellar region, and only rarely require decompressive surgery to treat symptoms. Pituitary abscesses are another rare lesion, and are an uncommon complication of pituitary surgery. A previously healthy 45 year old woman presented with a new finding of bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed a cystic sellar lesion with suprasellar extension and compression of the optic chiasm. Endoscopic transphenoidal surgery was performed and the lesion was found to be an arachnoid cyst. She was well immediately after the operation, but 1 week later presented with headaches, fever and worsening visual acuity. MRI showed a homogenous collection in the sellar region that was compressing the chiasm. The patient was treated with antibiotics, and a second transphenoidal operation was performed, with frank pus found in the pituitary fossa. Cultures of the fluid found during the operation grew Escherichia coli and Staphylococcus lugdunensis. Her symptoms resolved after the second operation, and formal visual fields and a pituitary hormone panel were normal at this time. We report on a rare case of a pituitary abscess complicating surgery for a sellar arachnoid cyst, and discuss management of these conditions.
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Affiliation(s)
| | - Joao Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Selfy Oswari
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, ON, Canada
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Mangussi-Gomes J, Gentil AF, Filippi RZ, Momesso RA, Handfas BW, Radvany J, Balsalobre L, Stamm AC. Sellar and suprasellar arachnoid cyst. EINSTEIN-SAO PAULO 2019; 17:eAI4269. [PMID: 30726308 PMCID: PMC6438669 DOI: 10.31744/einstein_journal/2019ai4269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/27/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | | | | | | | - João Radvany
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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9
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Rare Intrasellar Arachnoid Cyst Distinguishing From Other Benign Cystic Lesions and its Surgical Strategies. J Craniofac Surg 2019; 30:e400-e402. [DOI: 10.1097/scs.0000000000005315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Granular cell tumor of the infundibulum: a systematic review of MR-radiography, pathology, and clinical findings. J Neurooncol 2018; 140:181-198. [DOI: 10.1007/s11060-018-2986-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/19/2018] [Indexed: 10/28/2022]
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Abstract
The sellar region is a tiny anatomic compartment in which many lesions and developmental diseases can be found. If pituitary adenomas represent most of the sellar mass, it is important to recognize other pathologic conditions before any surgical procedure, because the optimal treatment may differ considerably from one lesion to another. A careful clinical evaluation followed by neuroimaging studies and an endocrinologic and ophtalmologic workup will lead, in most cases, to a diagnosis with near certainty. This article provides an overview of sellar diseases with emphasis on their most useful characteristics for clinical practice.
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Affiliation(s)
- Damien Bresson
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, Paris 75010, France
| | - Philippe Herman
- ENT Department, Lariboisière Hospital, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France
| | - Marc Polivka
- Department of Pathology, Lariboisiere Hospital, 2 rue Ambroise Paré, Paris 75010, France
| | - Sébastien Froelich
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France.
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Intrasellar arachnoid cyst: A case report and review of the literature. Int J Surg Case Rep 2016; 23:105-8. [PMID: 27107306 PMCID: PMC4855788 DOI: 10.1016/j.ijscr.2016.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Arachnoid cysts (ACs) are frequently found on intracranial imaging studies but intrasellar arachnoid cysts are rarely encountered. PRESENTATION OF CASE We present a 49-year old patient who had headaches for 6 months and cystic sellar mass was found in his cranial imaging. We operated him by transnasal transsphenoidal route. Our intraoperative diagnosis was an arachnoid cyst and pathologic studies verified our observation. He did well postoperatively and after a 1year follow-up he was left free from future follow-ups. DISCUSSION As common cystic lesions occupying the sellar region can simulate ACs both clinically and radiologically, neurosurgeon can fail to include ACs in making the initial diagnosis preoperatively. CONCLUSION Although a rare entity, arachnoid cysts should be considered in the differential diagnosis of sellar region.
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Badaoui M, Belabbes S, Darbi A, El Kharras A. [Intra and suprasellar arachnoid cyst: contribution of MRI]. Pan Afr Med J 2015; 22:245. [PMID: 26958108 PMCID: PMC4764312 DOI: 10.11604/pamj.2015.22.245.7535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/26/2015] [Indexed: 11/21/2022] Open
Abstract
Les kystes arachnoïdiens intrasellaires sont rares et souvent étendus en suprasellaire. Leur diagnostic doit être évoqué devant toute formation de nature kystique dont le signal est identique à celui du liquide cérébro-spinal. Nous rapportons le cas d'un kyste arachnoïdien de siège intra et suprasellaire révélé par une baisse de l'acuité visuelle et une hémianopsie bitemporale dont l'exploration par l'IRM cérébrale retrouve la formation kystique de signal liquidien identique à celui du LCS, avec une prise de contraste localisée de la paroi postéro-latérale gauche du kyste qui correspond à la glande hypophysaire déplacée et étalée. Un abord chirurgical par voie trans-sphénoïdale a permis d’évacuer le contenu kystique et de décomprimer les voies optiques. L’évolution a été marquée par une amélioration immédiate des perturbations visuelles.
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Affiliation(s)
- Mohamed Badaoui
- Service de Medecine Interne, 1er Centre Médico-chirurgical, Agadir, Maroc
| | - Soufiane Belabbes
- Service d'Imagerie Médicale. 1 Centre médico-chirurgical, Agadir, Maroc
| | - Abdellatif Darbi
- Service d'Imagerie Médicale, Hospital Militaire Mohamed V, Rabat, Maroc
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Ali ZS, Lang SS, Bakar D, Storm PB, Stein SC. Pediatric intracranial arachnoid cysts: comparative effectiveness of surgical treatment options. Childs Nerv Syst 2014; 30:461-9. [PMID: 24162618 DOI: 10.1007/s00381-013-2306-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE A variety of surgical approaches for the treatment of pediatric intracranial arachnoid cysts exist. In an effort to identify the optimal surgical treatment for this disorder, we developed a decision analytic model to evaluate outcomes of four surgical approaches in children. These included open craniotomy for cyst excision, open craniotomy for cyst fenestration, endoscopic cyst fenestration, and cystoperitoneal shunting. METHODS Pooled data were used to create evidence tables, from which we calculated incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) for the four surgical treatments. Our study incorporated data up to 5 years postsurgery. RESULTS We analyzed 1,324 cases from 36 case series. There were no significant differences in outcome among the four surgical strategies. The QALYs (maximum of 5) for surgical approaches resulted in a range from 4.79 (for open craniotomy and excision) to 4.92 (for endoscopic fenestration). CONCLUSIONS Overall quality of life is comparable between patients undergoing open craniotomy for cyst excision or fenestration, endoscopic fenestration, and cystoperitoneal shunting up to 5 years after surgery. While each approach offers unique advantages and disadvantages, an individualized treatment strategy should be employed in the setting of surgical outcome equipoise.
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Affiliation(s)
- Zarina S Ali
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA,
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Oyama K, Fukuhara N, Taguchi M, Takeshita A, Takeuchi Y, Yamada S. Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note. Neurosurg Rev 2013; 37:261-7; discussion 267. [PMID: 23999887 DOI: 10.1007/s10143-013-0496-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/06/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
Abstract
A less invasive transsphenoidal approach with a keyhole dural opening for intrasellar arachnoid cysts is described. This approach was used to address seven sellar cystic lesions with suprasellar extension; they were six intrasellar arachnoid cysts (IACs) and one Rathke's cleft cyst (RCC). In all cases, preoperative MRI revealed cerebrospinal fluid (CSF) intensity on both T1- and T2-weighted images. On preoperative contrast-enhanced MRI, five of the six IACs manifested posterior displacement of the flattened pituitary gland toward the dorsum sellae; one of the six IACs and the RCC exhibited a flattened pituitary gland on the anterior surface of the cyst. Wide cyst cisternostomy through a keyhole dural opening was carried out safely using a microscope with the support of a thin angled endoscope (30° and/or 70°, diameter 2.7 mm). As we aimed to avoid iatrogenic injury of the pituitary function, we found it difficult to obtain a sufficiently wide and precise opening of the cyst wall when the pituitary gland was located on the anterior surface of the cyst wall. Our approach facilitates safe cyst cisternostomy as wide as that obtainable by transcranial manipulation. In addition, CSF leakage is prevented by dural plasty using the fascia lata and stitching with 6-0 monofilament sutures. This technique can be adapted to address various sellar cystic lesions. However, as the posterior or anterior displacement of the normal pituitary gland in the presence of IACs or RCCs, respectively, affects the width of the cyst opening, our technique is more suitable for IACs than RCCs.
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Affiliation(s)
- Kenichi Oyama
- Department of Hypothalamic & Pituitary Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato, Tokyo, 1058470, Japan,
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Lorente-Muñoz A, Lisbona-Alquézar MP, Alberdi-Viñas J, Orduna-Martinez J, González-Martínez L, Fernández-Liesa R. [Intrasellar arachnoid cysts. Two case reports and literature review]. Neurocirugia (Astur) 2013; 24:277-82. [PMID: 23582225 DOI: 10.1016/j.neucir.2013.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 12/11/2012] [Accepted: 02/23/2013] [Indexed: 11/27/2022]
Abstract
Intrasellar arachnoid cysts are an uncommon pathology, with only a few cases reported in scientific literature. Their physiopathology is still unknown, with different hypothesis about their development. Differential diagnosis with other cystic sellar lesions is difficult. We report two cases of two intrasellar arachnoid cysts that were treated surgically using transsphenoidal approach and present a review of the literature.
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Affiliation(s)
- Asís Lorente-Muñoz
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España.
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Shim KW, Park EK, Lee YH, Kim SH, Kim DS. Transventricular endoscopic fenestration of intrasellar arachnoid cyst. Neurosurgery 2013; 72:520-8; discussion on 528. [PMID: 23511821 DOI: 10.1227/neu.0b013e318282a6e3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To manage arachnoid cysts, incorporation with the normal circulation is the single most important determinant of success. Although the postoperative cerebrospinal fluid leakage rate is 3.9% for all cases of transsphenoidal surgery, it is 21.4% for intrasellar arachnoid cysts. OBJECTIVE To present a safe, relatively easy, and effective treatment option for very rare intrasellar arachnoid cysts. METHODS We performed a prospective study of intrasellar cystic lesions without a solid portion. Endoscopic exploration and fenestration were performed for all lesions under neuronavigational guidance. We analyzed presenting symptoms, endocrinological status, and magnetic resonance images. RESULTS There were 2 male and 4 female patients with a mean age of 45 years (range, 27-67 years). All patients presented with the visual disturbance of bitemporal hemianopsia. Four patients had endocrinological symptoms including galactorrhea, dysmenorrhea, and diabetes insipidus. Endoscopic fenestration of the cyst was successfully performed in all patients. All patients were confirmed to have a pure cystic lesion, namely an arachnoid cyst. The follow-up period was 10 months on average (range, 6-12 months). Visual disturbance improved in 5 patients. Endocrinological problems persisted in all patients for 3 months and then normalized, with the exception of the patient with diabetes insipidus. There was no evidence of recurrence in any of the 6 patients in the 12-month postoperative imaging studies (median follow-up of 10 months). Two patients showed syndrome of inappropriate antidiuretic hormone at 2 and 4 weeks after the operation, but antidiuretic hormones recovered to normal levels after this time point. CONCLUSION Endoscopic fenestration of an intrasellar arachnoid cyst is a safe and simple procedure without serious complications.
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Affiliation(s)
- Kyu-Won Shim
- Pediatric Neurosurgery, Severance Children's Hospital, Department of Neurosurgery, Brain Korea 21 project for medical science, Yonsei University College of Medicine, Seoul, South Korea
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McLaughlin N, Vandergrift A, Ditzel Filho LF, Shahlaie K, Eisenberg AA, Carrau RL, Cohan P, Kelly DF. Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique. J Neurosurg 2012; 116:728-40. [DOI: 10.3171/2011.12.jns11399] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Symptomatic sellar arachnoid cysts (ACs) have typically been treated via the transsphenoidal route. After sellar cyst wall fenestration, some authors have advocated cyst wall resection and increasing communication between the AC and suprasellar subarachnoid space (SAS). This study is a report of the authors' experience using a simplified approach to reinforce a defective diaphragma sellae or unseen arachnoid diverticulum by deliberately not enlarging the AC-SAS communication and obliterating the cyst cavity with adipose tissue followed by skull base reconstruction.
Methods
A retrospective analysis was conducted of patients who underwent an endonasal transsphenoidal obliteration of symptomatic ACs with a fat graft and skull base repair.
Results
Between July 1998 and September 2010, 8 patients with a sellar AC were identified (6 women and 2 men, mean age 57 years). Clinical presentation included headache, pituitary dysfunction, and visual dysfunction (4 patients each group). Maximal cyst diameter averaged 22 mm (range 15–32 mm). In all cases the sellar communication to the SAS was deliberately not enlarged. The endoscope was used for visualization in 8 of 9 procedures. Postoperatively, headache improved in all 4 patients, vision in all 4 patients, and partial resolution of endocrine dysfunction (hyperprolactinemia and/or recurrent hyponatremia) occurred in 3 (75%) of 4 patients. No new endocrinopathy, CSF leak, meningitis, or neurological deficits occurred. Two patients experienced cyst reaccumulation: 1 symptomatic recurrence was treated with reoperation at 43 months postsurgery, and 1 asymptomatic partial recurrence continued to be monitored at 29 months postsurgery.
Conclusions
Sellar ACs can be effectively treated using endonasal fenestration and obliteration with fat with resultant reversal of presenting symptoms in the majority of patients. This simplified technique of AC cavity obliteration without enlarging communication to the SAS has a low risk of CSF leakage, and in most cases appears to effectively disrupt cyst progression, although longer follow-up is required to monitor for cyst recurrence.
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Affiliation(s)
- Nancy McLaughlin
- 1Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Alexander Vandergrift
- 1Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Leo F. Ditzel Filho
- 1Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Kiarash Shahlaie
- 1Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Amalia A. Eisenberg
- 1Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Ricardo L. Carrau
- 2Department of Head and Neck Surgery, Ohio State University, Columbus, Ohio; and
| | - Pejman Cohan
- 3Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Daniel F. Kelly
- 1Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
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Kumar J, Kumar A, Sharma R, Vashisht S. Magnetic Resonance Imaging of Sellar and Suprasellar Pathology: A Pictorial Review. Curr Probl Diagn Radiol 2007; 36:227-36. [DOI: 10.1067/j.cpradiol.2007.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Abstract
OBJECTIVE
To evaluate the clinical, endocrinological, and radiological presentation of nine cases of surgically verified intrasellar arachnoid cysts and to discuss the physiopathological mechanisms of formation of these cysts.
METHODS
Among 1540 patients presenting with pituitary lesions, nine presented with an intrasellar arachnoid cyst. Their charts were retrospectively reviewed.
RESULTS
Presenting symptoms included headache (n = 2), visual symptoms (n = 3), menstrual irregularities (n = 2), rapid weight gain (n = 1), vertigo (n = 1), and/or confusion (n = 1). Two cysts were discovered incidentally. T1-weighted magnetic resonance imaging scans showed an intrasellar cystic lesion in all cases, with a huge suprasellar extension in six cases. The cyst was of the same intensity as the cerebrospinal fluid (CSF) in only two patients. A transsphenoidal approach allowed the transdural aspiration of fluid and injection of a water-soluble contrast agent under mild pressure. In three patients, the contrast infiltrated along the pituitary stalk toward the subarachnoid spaces; in the other patients, it remained in the intrasellar compartment. Cyst membranes were removed as completely as possible with fenestration toward the subarachnoid spaces in communicating cysts. In spite of tight packing of the sella and sphenoid sinus, CSF fistulae requiring reoperation developed in two patients.
CONCLUSION
The clinical picture of an intrasellar arachnoid cyst resembles that of a nonfunctional pituitary adenoma. Magnetic resonance imaging scans typically show a cystic intrasellar lesion with suprasellar extension, containing isointense or, more often, hyperintense fluid on T1-weighted sequences. In spite of the risk of CSF fistulae, the preferred surgical approach is transsphenoidal. A physiopathological mechanism is proposed according to anatomic variations of the sellar diaphragma allowing penetration of subarachnoid spaces into the sellar compartment and their enlargement by a ball-valve mechanism.
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Affiliation(s)
- Annie S Dubuisson
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium.
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21
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Rennert J, Doerfler A. Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg 2006; 109:111-24. [PMID: 17126479 DOI: 10.1016/j.clineuro.2006.11.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 10/30/2006] [Accepted: 11/01/2006] [Indexed: 11/16/2022]
Abstract
The sellar and parasellar region is an anatomically complex area where a number of neoplastic, infectious, inflammatory, developmental and vascular pathologies can occur. Differentiation among various etiologies may not always be easy, since many of these lesions may mimic the clinical, endocrinologic and radiologic presentations of pituitary adenomas. The diagnosis of sellar lesions involves a multidisciplinary effort, and detailed endocrinologic, ophthalmologic and neurologic testing are essential. CT and, mainly, MRI are the imaging modalities to study and characterise normal anatomy and the majority of pathologic processes in this region. We here provide an overview of the most relevant MRI and CT characteristics together with clinical findings of pituitary tumors, vascular, inflammatory and infectious lesions found in the sellar/parasellar region in order to propose an appropriate differential diagnosis.
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Affiliation(s)
- Janine Rennert
- Department of Neuroradiology, University Hospital of Erlangen Medical School, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
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Yasuda K, Saitoh Y, Okita K, Morris S, Moriwaki M, Miyagawa JI, Yoshimine T. Giant Intrasellar Arachnoid Cyst Manifesting as Adrenal Insufficiency Due to Hypothalamic Dysfunction-Case Report-. Neurol Med Chir (Tokyo) 2005; 45:164-7. [PMID: 15782010 DOI: 10.2176/nmc.45.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 67-year-old man first noticed loss of pubic and axillary hair in 1992 and then a visual field defect in 2001. He experienced loss of consciousness attributed to hyponatremia in April 2002. Magnetic resonance imaging showed a giant intrasellar cystic mass, 40 mm in diameter, that had compressed the optic chiasm. The patient complained of chronic headache, and neurological examination revealed bitemporal hemianopsia. Preoperative endocrinological examination indicated adrenal insufficiency, and hypothyroidism due to hypothalamic dysfunction. The patient underwent endonasal transsphenoidal surgery. The cyst membrane was opened and serous fluid was drained. Histological examination identified the excised cyst membrane as arachnoid membrane. The patient's headaches resolved postoperatively, but the bitemporal hemianopsia and endocrinological function were unchanged. This arachnoid cyst associated with hypothalamic dysfunction might have been caused by an inflammatory episode in the suprasellar region.
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Affiliation(s)
- Keitaro Yasuda
- Department of Neurosurgery, Osaka University Graduate School of Medicine.
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Abstract
Whilst pituitary adenomas are the commonest cause of a sellar mass, there are a number of other neoplastic, infectious, inflammatory, developmental and vascular aetiologies that should be considered by the radiologist. We discuss and illustrate these lesions and indicate the various magnetic resonance imaging features that are helpful in formulating an appropriate differential diagnosis.
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Affiliation(s)
- S E J Connor
- Department of Neuroradiology, King's College Hospital, London, U.K.
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Abstract
The sella and parasellar region may be affected by a variety of disease states. Diseases of this region often result in visual disturbances because of the proximity of the sella to the optic pathways and cranial nerves. Knowledge of the pathological conditions affecting the sella and surrounding structures is important for the orbital imager.
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Affiliation(s)
- C E Swallow
- Department of Radiology, University of Utah Medical Center, Salt Lake City 84132, USA
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