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Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts

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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Funding

No funding was received for conducting this study.

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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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Informed consent was obtained from the patients included in this study.

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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). https://doi.org/10.1007/s11102-021-01187-8

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Keywords

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