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Rychen J, Constanzo F, Chan D, Kossler AL, Fernandez-Miranda JC. Anatomic and Surgical Considerations in the Management of a Sellar and Suprasellar Arachnoid Cyst: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01022. [PMID: 38198191 DOI: 10.1227/ons.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Jonathan Rychen
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Felipe Constanzo
- Department of Neurosurgery, Stanford University, Stanford, California, USA
- Department of Skull Base Surgery, Clinica Bio Bio, Concepcion, Chile
- Department of Neurological Surgery, Hospital Clinico Regional de Concepcion, Concepcion, Chile
| | - Daniel Chan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Stanford University, Stanford, California, USA
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Cabrilo I, Marcus HJ, Dorward NL. The cruciform drain: a technical note on the surgical management of cystic lesions of the sella. Br J Neurosurg 2023; 37:1379-1386. [PMID: 33263427 DOI: 10.1080/02688697.2020.1849546] [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: 07/12/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The postoperative recurrence of cystic lesions of the sella is frequent and may require further surgery for re-drainage. OBJECTIVE To tackle this problem, we propose to insert a small cross-shaped drain coursing from the cyst lumen to the suprasellar cistern. At this early stage of innovation, the technique is primarily intended for patients who present with a recurrence. METHODS The cruciform drain is fashioned from the tip of a ventricular catheter and is inserted under endoscopic vision. We retrospectively reviewed the pre- and postoperative records of patients in whom this technique was implemented. RESULTS A cruciform drain was placed in five patients since the introduction of the technique into our practice in 2018. The use of the cruciform drain did not impact upon the expected surgical workflow nor was it associated with adverse intraoperative events, but three patients did develop a postoperative CSF leak that was successfully treated in all cases. None of the patients showed re-collection of their cysts on early radiological follow-up. CONCLUSION The cruciform drain is intended to prevent the renewed build-up of cystic fluid by allowing it to flow through and around the drain into the subarachnoid space. We have modified our repair protocol in response to the observed high CSF leak rate, as a basis for further development of the technique. Studies involving long-term follow-up will also be required to assess its efficacy in reducing cyst recurrence.
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Affiliation(s)
- Ivan Cabrilo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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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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Azab WA, Khan T, Alqunaee M, Al Bader A, Yousef W. Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions. Adv Tech Stand Neurosurg 2023; 48:139-205. [PMID: 37770685 DOI: 10.1007/978-3-031-36785-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Endoscopic skull base surgery has become an integral part of the present neurosurgical armamentarium. The pioneering efforts in which the purely endoscopic transsphenoidal approach was introduced have triggered a growing tide of using the endoscopic endonasal procedures for a large variety of skull base lesions. Because of their anatomical peculiarities, lesions of the sellar and parasellar regions lend themselves very well to the endoscopic endonasal approaches. Apart from the common pathological entities, many other less frequent pathologies are encountered in the sellar and parasellar area. In this chapter, we review the surgical technique of the endoscopic endonasal transsphenoidal approach and its extensions applied to a variety of rare and uncommon pathological entities involving the sella turcica and clivus. An overview of these pathological entities is also presented and exemplified.
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Affiliation(s)
- Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Tufail Khan
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Marwan Alqunaee
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Abdullah Al Bader
- Rhinology - Endoscopic Sinus and Skull Base Surgery, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
| | - Waleed Yousef
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
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d'Artigues J, Graillon T, Boissonneau S, Farah K, Amodru V, Brue T, Fuentes S, Dufour H. Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts. Pituitary 2022; 25:191-200. [PMID: 34609694 DOI: 10.1007/s11102-021-01187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To report our experience of endoscopic endonasal obliteration of symptomatic sellar arachnoid cyst (SAC). METHODS From 2002 to 2019, we retrospectively reported the data of 17 cases of SAC operated in Timone University Hospital, Marseille, France. Preoperative clinical findings were collected including main symptoms, visual function and endocrinological assessment. Surgical procedure was homogeneous and consisted in endonasal fully endoscopic surgical obliteration of the cyst cavity with fat graft. Post-operative outcomes, complication and follow-up was reported. RESULTS Visual disorders and/or headaches were the main symptoms. Our technique provided improvement for 83.3% of the patients suffering from visual disturbance and for 87.5% of those suffering from headaches. We reported 2 cases of cerebrospinal fluid (CSF) leakage (11.8%), but no meningitis. One case of definitive diabetes insipidus occurred and one case of postoperative syndrome of inappropriate antidiuretic hormone secretion was temporary. There was one case of recurrence reported. The mean follow-up was 39 months. CONCLUSION Patients with symptomatic SAC can be treated successfully by endoscopic endonasal obliteration of the cyst. This simple technique offers true benefits for the patients without craniotomy, but the complication rate remains high especially with the risk of CSF leakage. Special attention to skull base opening and closing could reduce this risk.
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Affiliation(s)
- Jean d'Artigues
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France.
| | - Thomas Graillon
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
| | | | - Kaissar Farah
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
| | - Vincent Amodru
- Department of Endocrinology, Hôpital de La Conception, Marseille, France
| | - Thierry Brue
- Department of Endocrinology, Hôpital de La Conception, Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
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Jannelli G. Telemetric monitoring of intracystic pressure with sensor reservoir for recurrent sellar arachnoid cysts. BRAIN AND SPINE 2022; 2:100874. [PMID: 36248164 PMCID: PMC9562225 DOI: 10.1016/j.bas.2022.100874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gianpaolo Jannelli
- Corresponding author. Department of Neurosurgery B, Skull Base Unit, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, 59 Boulevard Pinel, 69500, Bron, France.
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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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Aljuboori Z, Burke W, Yeo H, McCallum A, Clark J, Williams B. Orbitofrontal approach for the fenestration of a symptomatic sellar arachnoid cyst. Surg Neurol Int 2020; 11:10. [PMID: 31966929 PMCID: PMC6969377 DOI: 10.25259/sni_541_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 11/04/2022] Open
Abstract
Background Sellar arachnoid cysts (SACs) are rare lesions and incidentally found on brain imaging. The pathophysiology is poorly understood. Some authors suggested that SACs develop as a herniation of arachnoid membrane through the diaphragma sellae followed by cyst formation. Furthermore, Meyer et al. postulated that SACs are formed by splitting of the arachnoid layers. Symptomatic SACs present with headache, visual field deficit, or pituitary dysfunction. The data are limited on the indications and timing for intervention. We present a case of symptomatic SAC that was fenestrated using orbitofrontal approach. Case Description A 64-year-old female presented with chronic headaches and blurriness of vision. She was previously diagnosed with diabetes insipidus (DI) that was treated with desmopressin, magnetic resonance imaging (MRI) of her brain at that time was normal. Later on, she developed severe headaches that were managed medically. A year later, she had an episode of generalized seizure that led to the discovery of SAC on brain MRI. On examination, she had a left-sided monocular temporal hemianopia. The patient underwent an orbitofrontal craniotomy for fenestration of the SAC. At 6-month follow-up, her headaches had significantly improved with the resolution of the visual deficit. In addition, the DI had resolved, and the desmopressin was discontinued. Conclusion SACs are rare with no consensus on the indications for surgery. Our experience suggests that fenestration of SAC through transcranial approach is a valid option for patients with visual deficit and/or pituitary dysfunction.
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Affiliation(s)
- Zaid Aljuboori
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - William Burke
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Heegok Yeo
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Abigail McCallum
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Jeremy Clark
- Departments of Ophthalmology, University of Louisville, Louisville, Kentucky
| | - Brian Williams
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky
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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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Yamamuro S, Yoshimura S, Oshima H, Yoshino A. A case of Rathke cleft cyst concomitant with sellar/suprasellar arachnoid cyst. Acta Neurol Belg 2017; 117:561-563. [PMID: 27734277 PMCID: PMC5440490 DOI: 10.1007/s13760-016-0705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/27/2016] [Indexed: 11/02/2022]
Affiliation(s)
- Shun Yamamuro
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi kamichou, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Sodai Yoshimura
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi kamichou, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hideki Oshima
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi kamichou, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi kamichou, Itabashi-ku, Tokyo, 173-8610, Japan
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Temiz C, Kutlay M, Safali M, Kural C, Ezgu C, Izci Y. Endoscopic Removal of Suprasellar Colloid Cyst with Interpeduncular and Prepontine Cisterns Extension. World Neurosurg 2017; 98:869.e7-869.e12. [DOI: 10.1016/j.wneu.2016.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 12/14/2022]
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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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Dawkins RL, Hackney JR, Riley KO. Penetration of an Optic Nerve by a Sellar/Suprasellar Arachnoid Cyst. World Neurosurg 2016; 87:662.e7-11. [DOI: 10.1016/j.wneu.2015.10.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Endoscopic transsphenoidal cisternostomy for nonneoplastic sellar cysts. BIOMED RESEARCH INTERNATIONAL 2015; 2015:389474. [PMID: 25685785 PMCID: PMC4317582 DOI: 10.1155/2015/389474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/11/2014] [Accepted: 10/11/2014] [Indexed: 11/18/2022]
Abstract
Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant. Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke's cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable. Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.
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Ditzel Filho LFS, Prevedello DM, Patel MR, Otto BA, Carrau RL. Perioperative Considerations: Planning, Intraoperative and Postoperative Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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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Al-Holou WN, Terman S, Kilburg C, Garton HJL, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in adults. J Neurosurg 2013; 118:222-31. [DOI: 10.3171/2012.10.jns12548] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined.
Methods
We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis.
Results
A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period.
Conclusions
Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.
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