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Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts



To report our experience of endoscopic endonasal obliteration of symptomatic sellar arachnoid cyst (SAC).


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.


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.


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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  1. 1.

    Al-Holou WN, Terman S, Kilburg C, Garton HJL, Muraszko KM, Maher CO (2013) Prevalence and natural history of arachnoid cysts in adults. J Neurosurg 118(2):222–231.

    Article  PubMed  Google Scholar 

  2. 2.

    Dubuisson AS, Stevenaert A, Martin DH, Flandroy PP (2007) Intrasellar arachnoid cysts. Neurosurgery 61(3):505–513.

    Article  PubMed  Google Scholar 

  3. 3.

    Chen B, Miao Y, Hu Y et al (2019) Rare intrasellar arachnoid cyst distinguishing from other benign cystic lesions and its surgical strategies. J Craniofac Surg 30(5):e400–e402.

    Article  PubMed  Google Scholar 

  4. 4.

    Liu H, Lu X, Hang W, Liu G (2019) Magnetic resonance imaging characteristics and differential diagnosis of common sellar cystic lesions. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 54(11):819–825.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    McLaughlin N, Vandergrift A, Ditzel Filho LF et al (2012) Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique. J Neurosurg 116(4):728–740.

    Article  PubMed  Google Scholar 

  6. 6.

    Cappabianca P, de Divitiis E (2004) Endoscopy and transsphenoidal surgery. Neurosurgery 54(5):1043–1048.

    Article  PubMed  Google Scholar 

  7. 7.

    Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):1–12.

    Article  Google Scholar 

  8. 8.

    Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe H-J, Petersenn S (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 156(2):203–216.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Baskin DS, Wilson CB (1984) Transsphenoidal treatment of non-neoplastic intrasellar cysts: a report of 38 cases. J Neurosurg 60(1):8–13.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Zayour DH, Selman WR, Arafah BM (2004) Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metab 89(11):5649–5654.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR (2000) The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab 85(5):1789–1793.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Chanson P, Raverot G, Castinetti F et al (2015) Management of clinically non-functioning pituitary adenoma. Ann Endocrinol 76(3):239–247.

    Article  Google Scholar 

  13. 13.

    Meyer FB, Carpenter SM, Laws ER (1987) Intrasellar arachnoid cysts. Surg Neurol 28(2):105–110.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Campero A, Tróccoli G, Martins C, Fernandez-Miranda JC, Yasuda A, Rhoton AL (2006) Microsurgical approaches to the medial temporal region: an anatomical study. Neurosurgery 59(4 Suppl 2):ONS-279-ONS-307.

    Article  Google Scholar 

  15. 15.

    Hornig GW, Zervas NT (1992) Slit defect of the diaphragma sellae with valve effect: observation of a “slit valve.” Neurosurgery 30(2):265–267.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Shim K-W, Park E-K, Lee Y-H, Kim S-H, Kim D-S (2013) Transventricular endoscopic fenestration of intrasellar arachnoid cyst. Neurosurgery 72(4):520–528.

    Article  PubMed  Google Scholar 

  17. 17.

    Magro E, Graillon T, Lassave J et al (2016) Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients. World Neurosurg 89:442–453.

    Article  PubMed  Google Scholar 

  18. 18.

    Roca E, Penn DL, Safain MG, Burke WT, Castlen JP, Laws ER (2019) Abdominal fat graft for sellar reconstruction: retrospective outcomes review and technical note. Oper Neurosurg Hagerstown Md 16(6):667–674.

    Article  Google Scholar 

  19. 19.

    Catapano D, Sloffer CA, Frank G, Pasquini E, D’Angelo VA, Lanzino G (2006) Comparison between the microscope and endoscope in the direct endonasal extended transsphenoidal approach: anatomical study. J Neurosurg 104(3):419–425.

    Article  PubMed  Google Scholar 

  20. 20.

    Bakhshi SK, Suhail N, Mitha R, Moazzam M, Zahid N, Shamim MS (2020) Lumbar drain for temporary cerebrospinal fluid diversion: factors related to the risks of complications at a University Hospital. World Neurosurg 143:e193–e198.

    Article  PubMed  Google Scholar 

  21. 21.

    Shin JL, Asa SL, Woodhouse LJ, Smyth HS, Ezzat S (1999) Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab 84(11):3972–3982.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Oyama K, Fukuhara N, Taguchi M, Takeshita A, Takeuchi Y, Yamada S (2014) Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note. Neurosurg Rev 37(2):261–267.

    Article  PubMed  Google Scholar 

  23. 23.

    Su Y, Ishii Y, Lin C-M, Tahara S, Teramoto A, Morita A (2015) Endoscopic transsphenoidal cisternostomy for nonneoplastic sellar cysts. BioMed Res Int 2015:389474.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Castle-Kirszbaum MD, Uren B, King J, Wang YY, Goldschlager T (2018) Glimpse into pathophysiology of sellar arachnoid cysts. World Neurosurg 119:381–383.

    Article  PubMed  Google Scholar 

  25. 25.

    Aljuboori Z, Burke W, Yeo H, McCallum A, Clark J, Williams B (2020) Orbitofrontal approach for the fenestration of a symptomatic sellar arachnoid cyst. Surg Neurol Int 11:10.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Cavallo LM, Prevedello D, Esposito F et al (2008) The role of the endoscope in the transsphenoidal management of cystic lesions of the sellar region. Neurosurg Rev 31(1):55–64.

    Article  PubMed  Google Scholar 

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Correspondence to Jean d’Artigues.

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The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. The Human Investigation Committee (IRB) of College de Neurochirurgie approved this study. No. IRB00011687 Collège de neurochirurgie IRB #1: 2021/19.

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d’Artigues, J., Graillon, T., Boissonneau, S. et al. Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts. Pituitary (2021).

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  • Intrasellar cyst
  • Endoscopic surgery
  • Cyst obliteration
  • Endonasal approach
  • Skull base
  • Arachnoid cysts