Endoscopic Transnasal Transsphenoidal Management of Sellar/suprasellar Arachnoid Cyst: A Case Report and Literature Review

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2023 May 8

PMID 37151455

Authors

Maruf Matmusaev

Tadashi Watanabe

Kenichiro Iwami

Tokhir Akhmediev

Affiliations

Soon will be listed here.

Abstract

Background: Arachnoid cysts (ACs) are collections of cerebrospinal fluids (CSFs) that develop within the arachnoid layer of the meninges. Sellar ACs are comparatively rare. In general, ACs account for approximately 1% of all intracranial mass lesions, and sellar ACs are 3% of all intracranial ACs. An endoscopic transnasal transsphenoidal approach for the treatment of ACs by fenestrating the cyst's wall and connecting with the subarachnoid space is the most optimal option.

Case Description: A 74-year-old woman whose sellar AC was diagnosed on magnetic resonance imaging a year ago was admitted to our hospital with complaints of bitemporal hemianopia and diminished visual acuity in the past 2 months. Sellar AC was diagnosed based on the clinical history and presentation, as well as neurologic, endocrinologic, and ophthalmologic examinations, including visual acuity and visual field examination, and additional imaging findings. The patient with a sellar/suprasellar AC was treated by an endoscopic transnasal transsphenoidal approach with cyst drainage and perforation of the lamina terminalis. Postoperatively, the visual disturbances improved markedly. No surgery-related complications occurred.

Conclusion: The endoscopic transnasal transsphenoidal approach remains a minimally invasive and preferred approach for the treatment of sellar/suprasellar ACs. Hermetically reconstructing the sellar floor is an effective method to prevent CSF leakage.

Citing Articles

A Case of Sellar Arachnoid Cyst Operated Using the Endoscopic Supraorbital Keyhole Approach.

Yamashiro K, Higashiguchi S, Wakako A, Omi T, Hayakawa M, Hirose Y Neurosurg Pract. 2025; 4(4):e00069.

PMID: 39959391 PMC: 11809967. DOI: 10.1227/neuprac.0000000000000069.

References

Shim K, Park E, Lee Y, Kim S, Kim D . Transventricular endoscopic fenestration of intrasellar arachnoid cyst. Neurosurgery. 2013; 72(4):520-8. DOI: 10.1227/NEU.0b013e318282a6e3. View

Saeki N, Tokunaga H, Hoshi S, Sunada S, Sunami K, Uchino F . Delayed postoperative CSF rhinorrhea of intrasellar arachnoid cyst. Acta Neurochir (Wien). 1999; 141(2):165-9. DOI: 10.1007/s007010050281. View

Matmusaev M, Kumar R, Yamada Y, Nagatani T, Kawase T, Tanaka R . Endoscopic Microvascular Decompression for Hemifacial Spasm. Asian J Neurosurg. 2021; 15(4):833-838. PMC: 7869256. DOI: 10.4103/ajns.AJNS_152_20. View

Ishii Y, Tahara S, Oyama K, Kitamura T, Teramoto A . Easy slip-knot: a new simple tying technique for deep sutures. Acta Neurochir (Wien). 2011; 153(7):1543-5. DOI: 10.1007/s00701-011-0988-3. View

Shin J, Asa S, Woodhouse L, Smyth H, Ezzat S . Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke's cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab. 1999; 84(11):3972-82. DOI: 10.1210/jcem.84.11.6114. View

Spaziante R, de Divitiis E, Stella L, Cappabianca P, Donzelli R . Benign intrasellar cysts. Surg Neurol. 1981; 15(4):274-82. DOI: 10.1016/s0090-3019(81)80007-9. View

Guduk M, HamitAytar M, Sav A, Berkman Z . Intrasellar arachnoid cyst: A case report and review of the literature. Int J Surg Case Rep. 2016; 23:105-8. PMC: 4855788. DOI: 10.1016/j.ijscr.2016.03.033. View

Jho H, Carrau R . Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note. Acta Neurochir (Wien). 1996; 138(12):1416-25. DOI: 10.1007/BF01411120. View

Weil R . Rapidly progressive visual loss caused by a sellar arachnoid cyst: reversal with transsphenoidal microsurgery. South Med J. 2002; 94(11):1118-21. DOI: 10.1097/00007611-200111000-00016. View

10.

Su Y, Ishii Y, Lin C, Tahara S, Teramoto A, Morita A . Endoscopic transsphenoidal cisternostomy for nonneoplastic sellar cysts. Biomed Res Int. 2015; 2015:389474. PMC: 4317582. DOI: 10.1155/2015/389474. View

11.

Mangussi-Gomes J, Gentil A, Filippi R, Momesso R, Handfas B, Radvany J . Sellar and suprasellar arachnoid cyst. Einstein (Sao Paulo). 2019; 17(1):eAI4269. PMC: 6438669. DOI: 10.31744/einstein_journal/2019AI4269. View

12.

Stein S . Intracranial developmental cysts in children: treatment by cystoperitoneal shunting. Neurosurgery. 1981; 8(6):647-50. DOI: 10.1227/00006123-198106000-00002. View

13.

Dawkins R, Hackney J, Riley K . Penetration of an Optic Nerve by a Sellar/Suprasellar Arachnoid Cyst. World Neurosurg. 2015; 87:662.e7-11. DOI: 10.1016/j.wneu.2015.10.077. View

14.

Horiguchi K, Murai H, Hasegawa Y, Hanazawa T, Yamakami I, Saeki N . Endoscopic endonasal skull base reconstruction using a nasal septal flap: surgical results and comparison with previous reconstructions. Neurosurg Rev. 2010; 33(2):235-41. DOI: 10.1007/s10143-010-0247-8. View

15.

Hornig G, Zervas N . Slit defect of the diaphragma sellae with valve effect: observation of a "slit valve". Neurosurgery. 1992; 30(2):265-7. DOI: 10.1227/00006123-199202000-00022. View

16.

Park K, Gwak H, Hong E, Lee S . Inflamed symptomatic sellar arachnoid cyst: case report. Brain Tumor Res Treat. 2014; 1(1):28-31. PMC: 4027118. DOI: 10.14791/btrt.2013.1.1.28. View

17.

Aljuboori Z, Burke W, Yeo H, McCallum A, Clark J, Williams B . Orbitofrontal approach for the fenestration of a symptomatic sellar arachnoid cyst. Surg Neurol Int. 2020; 11:10. PMC: 6969377. DOI: 10.25259/SNI_541_2019. View

18.

Baskin D, Wilson C . Transsphenoidal treatment of non-neoplastic intrasellar cysts. A report of 38 cases. J Neurosurg. 1984; 60(1):8-13. DOI: 10.3171/jns.1984.60.1.0008. View

19.

Shim K, Lee Y, Park E, Park Y, Choi J, Kim D . Treatment option for arachnoid cysts. Childs Nerv Syst. 2009; 25(11):1459-66. DOI: 10.1007/s00381-009-0930-7. View

20.

Pierre-Kahn A, Capelle L, Brauner R, Sainte-Rose C, Renier D, Rappaport R . Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg. 1990; 73(3):355-9. DOI: 10.3171/jns.1990.73.3.0355. View