Zmiany torbielowate okolicy siodłowo-nadsiodłowej — diagnostyka i leczenie

Abstract

The differentiation of cystic lesions located in the sellar-suprasellar region is a significant problem in clinical practice because of the similarities in their clinical, radiological, and even histopathological picture. Arriving at the right diagnosis is vital for taking appropriate therapeutic decisions. The most frequent clinical manifestation of lesions located in the sellar-suprasellar region is headache. It often co-exists with symptoms of anterior pituitary gland insufficiency or hyperprolactinaemia caused by compression of the pituitary stalk. Diabetes insipidus, obe-sity, mental disorders, and circadian rhythm disorders may be associated with lesions penetrating the suprasellar space. It is extremely important to rule out the possible coexistence of pituitary microadenoma and Rathke's cleft cyst, which became possible with the use of ¹¹C-methionine positron emission tomography/computed tomography (C-MET PET/CT). Reports from literature indicate that pituitary microadenoma may coexist with Rathke's cleft cyst in 10% of patients. Cystic lesions of the sellar-suprasellar region should also be differentiated from a cystic pituitary adenoma or abscess. The first-choice therapy in symptomatic cystic lesions of the sellar-suprasellar region is neurosurgery, which usually relieves headache and improves vision impairment, while less frequently restores normal pituitary function. In suprasellar lesions, neurosurgery may trig-ger or aggravate pre-existing symptoms of damage to the hypothalamus. Patients undergoing neurosurgery for cystic lesions located in the sellar-suprasellar region should be monitored for a few years due to their high recurrence rate, potential malignant transformation of these lesions, and possible adenoma development through metaplasia. The advent of targeted therapy of the BRAF/MEK pathway is associated with new therapeutic opportunities for patients with craniopharyngiomas.

The 1 μg Synacthen stimulation test in the diagnosis of secondary adrenal insufficiency in patients with Rathke’s cleft cyst and empty sella syndrome

“…They require clinical and hormonal assessment and further follow-up due to the risk of hypopituitarism, coexisting pituitary tumour and the risk of cyst growth. The differentiation between cystic lesions may be difficult and, as well as RCC and PESS, should include craniopharyngioma, cystic pituitary adenoma, pituitary aneurysm, secondary empty sella syndrome, pituitary abscess, intrasellar arachnoid cyst, epidermoid cyst, and xanthogranuloma [1,5].…”

“…Currently, cystic lesions of the sellar region are frequently diagnosed in imaging tests and post-mortem examinations. The most common is Rathke's cleft cyst (RCC); its incidence is estimated at approximately 20% [1]. Despite having a different pathogenesis, RCC requires a differential diagnosis with primary empty sella syndrome (PESS) in imaging studies.…”

Machine Learning Approaches to Differentiate Sellar-Suprasellar Cystic Lesions on Magnetic Resonance Imaging

“…These results suggest that there are clear differences in their imaging. Previous studies have described the image identification of craniopharyngioma in terms of volume, calcification, and shape [28]. That is the basis for its outstanding differences in radiomic features.…”

Assessment of quality of life in patients with craniopharyngioma and identification of risk factors for compromised overall wellness

“…The related clinical manifestations include visual impairment, headache, and hypothalamic/pituitary hormone deficiencies ( 1 ). Besides, craniopharyngiomas involving the hypothalamic area are prone to be associated with diabetes insipidus, obesity, mental disorders, and circadian rhythm disorders ( 2 ). With the advancement of treatment, mortality of these pathological conditions are decreasing and long-term survival becomes feasible ( 3 , 4 ).…”