The Algorithm of the Treatment and Diagnostic Strategy for cystic formations of the chiasmal-sellar region

Abstract

Due to the rare occurrence of cysts of the chiasmosellar region, neurologists and neurosurgeons do not always have experience with such a pathology. Additional difficulties are made by the difficulty of differential diagnosis due to the identical clinical symptoms of the formation of the chiasmal-sellar region and the frequent incorrect interpretation of neuroimaging data. But conducting an accurate preoperative differential diagnosis of cysts of the chiasmosellar region is an important step in preparing for surgical treatment, which allows you to determine the surgical tactics in advance, because each group of cysts of the chiasmosellar region has its own characteristics of surgical treatment, which can significantly reduce the number of complications and minimize the number of recidivities. The aim of this study was to improve the diagnosis and treatment of patients with cysts of the chiasmal-sellar region by developing an optimal diagnostic and treatment algorithm. For this, from 2009 to 2018, the medical documentation of 1740 patients was analyzed, of which 94 case histories were operated on with transsphenoidal endoscopic access for cystic pituitary adenomas and cysts of the chiasmosellar region. Patients were divided into 5 groups according to nosology. We analyzed the clinical picture, laboratory test data and MRI, features of surgical treatment and postoperative outcomes in each group. All obtained data were subjected to statistical analysis, on the basis of which the distinctive diagnostic and surgical features inherent in each group were determined. All the data obtained are summarized in a diagnostic and treatment algorithm, which allows for accurate differential diagnosis, based on which the specialist, using the developed algorithm, can determine the further treatment tactics and, if necessary, determine in advance the features of surgical treatment.