Endoscopic treatment of sellar arachnoid cysts via a simple cyst-opening technique: Long-term outcomes from a single center

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.

Intrasellar arachnoid cyst: A case report and review of the literature

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.