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.
Similar content being viewed by others
References
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. https://doi.org/10.3171/2012.10.JNS12548
Dubuisson AS, Stevenaert A, Martin DH, Flandroy PP (2007) Intrasellar arachnoid cysts. Neurosurgery 61(3):505–513. https://doi.org/10.1227/01.NEU.0000290896.69825.40
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. https://doi.org/10.1097/SCS.0000000000005315
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. https://doi.org/10.3760/cma.j.issn.1673-0860.2019.11.004
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. https://doi.org/10.3171/2011.12.JNS11399
Cappabianca P, de Divitiis E (2004) Endoscopy and transsphenoidal surgery. Neurosurgery 54(5):1043–1048. https://doi.org/10.1227/01.neu.0000119325.14116.9c
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. https://doi.org/10.3171/foc.2005.19.1.4
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. https://doi.org/10.1530/eje.1.02326
Baskin DS, Wilson CB (1984) Transsphenoidal treatment of non-neoplastic intrasellar cysts: a report of 38 cases. J Neurosurg 60(1):8–13. https://doi.org/10.3171/jns.1984.60.1.0008
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. https://doi.org/10.1210/jc.2004-0884
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. https://doi.org/10.1210/jcem.85.5.6611
Chanson P, Raverot G, Castinetti F et al (2015) Management of clinically non-functioning pituitary adenoma. Ann Endocrinol 76(3):239–247. https://doi.org/10.1016/j.ando.2015.04.002
Meyer FB, Carpenter SM, Laws ER (1987) Intrasellar arachnoid cysts. Surg Neurol 28(2):105–110. https://doi.org/10.1016/0090-3019(87)90081-4
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. https://doi.org/10.1227/01.NEU.0000223509.21474.2E
Hornig GW, Zervas NT (1992) Slit defect of the diaphragma sellae with valve effect: observation of a “slit valve.” Neurosurgery 30(2):265–267. https://doi.org/10.1227/00006123-199202000-00022
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. https://doi.org/10.1227/NEU.0b013e318282a6e3
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. https://doi.org/10.1016/j.wneu.2016.02.059
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. https://doi.org/10.1093/ons/opy219
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. https://doi.org/10.3171/jns.2006.104.3.419
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. https://doi.org/10.1016/j.wneu.2020.07.120
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. https://doi.org/10.1210/jcem.84.11.6114
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. https://doi.org/10.1007/s10143-013-0496-4
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. https://doi.org/10.1155/2015/389474
Castle-Kirszbaum MD, Uren B, King J, Wang YY, Goldschlager T (2018) Glimpse into pathophysiology of sellar arachnoid cysts. World Neurosurg 119:381–383. https://doi.org/10.1016/j.wneu.2018.08.111
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. https://doi.org/10.25259/SNI_541_2019
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. https://doi.org/10.1007/s10143-007-0098-0
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
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.
Informed consent
Informed consent was obtained from the patients included in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
d’Artigues, J., Graillon, T., Boissonneau, S. et al. Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts. Pituitary 25, 191–200 (2022). https://doi.org/10.1007/s11102-021-01187-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-021-01187-8