Surgical Management of Symptomatic Intrasellar Arachnoid Cysts. Two Case Reports.

Miyamoto, Tadashi; Ebisudani, D; Kitamura, Katsuji; Ohshima, Tsutomu; Horiguchi, Hironori; Saijo, Nagahiro

doi:10.2176/nmc.39.941

Cited by 26 publications

(25 citation statements)

References 14 publications

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“…We considered TSA as an appropriate surgical approach in this case because suprasellar extension was not marked and the cyst was relatively small in size. Miyamoto et al [10] suggested that making a full fenestration with the cisternal space is important for the surgical treatment of intrasellar ACs. In addition, they recommended not to open the roof of the cyst, if possible, since complications due to CSF leakage may occur in TSA surgery, and excision of the cyst wall via craniotomy is appropriate for a large sellar AC.…”

Section: Discussionmentioning

confidence: 99%

Inflamed Symptomatic Sellar Arachnoid Cyst: Case Report

Park

Gwak

Hong

et al. 2013

Brain Tumor Res Treat

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Sellar arachnoid cysts are rare; an infected arachnoid cyst is extremely rare as only one case has been reported to date in the literature. Here, we report a patient with an infected or inflamed sellar arachnoid cyst that was successfully treated with transsphenoidal surgery (TSA). A 53-year-old female with a history of chronic sinusitis developed a headache 5 months ago, and one month before admission polyuria, polydipsia, and abnormal vaginal bleeding occurred. The magnetic resonance imaging (MRI) showed a sellar cystic mass with a thickened pituitary stalk. Preoperative hormonal study revealed normal pituitary hormone levels except for a moderate elevation of prolactin. She was diagnosed with diabetes insipidus of the central nervous system origin based on a water-deprivation test. TSA was performed under an impression of symptomatic Rathke's cleft cyst according to the MRI findings. Intraoperative findings showed confirmation of turbid intracystic contents, but micro-organisms were unidentified on microbial culture. Pathology of the cyst wall revealed inflamed meningoepithelial lining cells compatible with an arachnoid cyst.

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Section: Discussionmentioning

confidence: 99%

Inflamed Symptomatic Sellar Arachnoid Cyst: Case Report

Park

Gwak

Hong

et al. 2013

Brain Tumor Res Treat

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“…Overall, ACs comprise only approximately 1% of intracranial spaceoccupying masses, and sellar ACs comprise roughly 3% of all intracranial ACs. 24 Excluding our series presented here, only 68 other cases of sellar ACs have been reported in the English and French literature. While other cystic parasellar masses are more common, such as cystic pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts, the rarity of sellar ACs does not preclude the need for surgical intervention when they become symptomatic.…”

mentioning

confidence: 86%

“…6,26 Early on, some cases were addressed through a transcranial approach. 2,17,24,25 However, the majority of more recent symptomatic ACs have been fenestrated via the transsphenoidal route (Table 3). Although fenestration of the anterior cyst membrane is an essential initial entry point using the transsphenoidal approach, the subsequent intrasellar management of these ACs has been inconsistent among case reports and even within series.…”

Section: Surgical Management Of Intrasellar Acsmentioning

confidence: 99%

“…1,5,6,12,14,16,17,[22][23][24][25][26][27][28][32][33][34] Dietemann and colleagues 5 first described the use of the endoscope to explore the cystic cavity, which lead to the finding of a communication between the cyst and the suprasellar SAS in one of their cases. More recently, Cavallo and colleagues 4 in a multicenter study recognized the role of the endoscope in the transsphenoidal management of sellar cystic lesions.…”

Section: Surgical Management Of Intrasellar Acsmentioning

confidence: 99%

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Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique

McLaughlin

Vandergrift

Filho

et al. 2012

JNS

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Sellar ACs can be effectively treated using endonasal fenestration and obliteration with fat with resultant reversal of presenting symptoms in the majority of patients. This simplified technique of AC cavity obliteration without enlarging communication to the SAS has a low risk of CSF leakage, and in most cases appears to effectively disrupt cyst progression, although longer follow-up is required to monitor for cyst recurrence.

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“…6,7) Intrasellar arachnoid cyst is rare, [2][3][4][5][6]8,10,11,13,17,19,20) and it is important, although difficult, to differentiate this type of cyst from other cystic lesions such as Rathke's cleft cyst, pituitary cyst (parenchymal or adenomatous), craniopharyngioma, pars intermedia cyst, and other miscellaneous cysts (epidermoid cyst, cysticercosis cyst) when considering the prognosis. 9,14) Hypothalamic dysfunction due to an intrasellar arachnoid cyst is extremely rare.…”

Section: Introductionmentioning

confidence: 99%

Giant Intrasellar Arachnoid Cyst Manifesting as Adrenal Insufficiency Due to Hypothalamic Dysfunction-Case Report-

Yasuda

Saitoh

Okita

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 67-year-old man first noticed loss of pubic and axillary hair in 1992 and then a visual field defect in 2001. He experienced loss of consciousness attributed to hyponatremia in April 2002. Magnetic resonance imaging showed a giant intrasellar cystic mass, 40 mm in diameter, that had compressed the optic chiasm. The patient complained of chronic headache, and neurological examination revealed bitemporal hemianopsia. Preoperative endocrinological examination indicated adrenal insufficiency, and hypothyroidism due to hypothalamic dysfunction. The patient underwent endonasal transsphenoidal surgery. The cyst membrane was opened and serous fluid was drained. Histological examination identified the excised cyst membrane as arachnoid membrane. The patient's headaches resolved postoperatively, but the bitemporal hemianopsia and endocrinological function were unchanged. This arachnoid cyst associated with hypothalamic dysfunction might have been caused by an inflammatory episode in the suprasellar region.

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Surgical Management of Symptomatic Intrasellar Arachnoid Cysts. Two Case Reports.

Cited by 26 publications

References 14 publications

Inflamed Symptomatic Sellar Arachnoid Cyst: Case Report

Inflamed Symptomatic Sellar Arachnoid Cyst: Case Report

Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique

Giant Intrasellar Arachnoid Cyst Manifesting as Adrenal Insufficiency Due to Hypothalamic Dysfunction-Case Report-

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