Endoscopic Treatment of Sellar Arachnoid Cysts via a Simple Cyst-Opening Technique: Long-Term Outcomes From a Single Center

Aristotelis Kalyvas; Matthias Milesi; Matheus Leite; Kaiyun Yang; Leslie St Jacques; Allan Vescan; Ozgur Mete; Shereen Ezzat; Gelareh Zadeh; Fred Gentili

doi:10.1016/j.wneu.2022.02.072

Endoscopic Treatment of Sellar Arachnoid Cysts via a Simple Cyst-Opening Technique: Long-Term Outcomes From a Single Center

World Neurosurg. 2022 May:161:e625-e634. doi: 10.1016/j.wneu.2022.02.072. Epub 2022 Feb 23.

Authors

Affiliations

¹ Division of Neurosurgery, Department of Surgery, University Health Network/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: aristoteliskalyvas@gmail.com.
² Division of Neurosurgery, Department of Surgery, University Health Network/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
³ Division of Neurosurgery, Department of Surgery, University Health Network/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Endocrine Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.

PMID: 35217229
DOI: 10.1016/j.wneu.2022.02.072

Abstract

Background: Sellar arachnoid cysts (SACs) are rare lesions that require treatment only if symptomatic. The endoscopic endonasal approach has been widely used. Despite their simple cystic appearance and the straight-forward surgical intervention, important associated risks exist, with cerebrospinal fluid (CSF) leak the prevalent risk.

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 with nasoseptal flaps was used.

Results: A total of 10 patients were identified (7 women and 3 men; median age, 54.5 years; range, 20-77 years). Of the 10 patients, 8 had had newly diagnosed SACs and 2 patients had had recurrence from a previously microsurgically fenestrated SAC. Eight patients had presented with visual symptoms, one with visual symptoms and fatigue, and one with intractable headaches. Neuro-ophthalmological and endocrinological assessments had revealed visual field deficits in 6, visual acuity decline in 5, and hypopituitarism in 2 patients. The median calculated volume was 1.71 mL (range, 0.27-2.54 mL). Postoperatively, no CSF leak and no further surgical complications were noted. The visual field had improved in 4 of 6 patients and visual acuity had improved in 4 of 5 patients. Anterior pituitary function had improved in 1, worsened in 1, and remained stable in 8 patients. One patient had developed diabetes insipidus. One recurrence was recorded at 54 months postoperatively.

Conclusions: The results from the present study have shown that SACs can be effectively treated using a simple cyst-opening technique. The routine use of nasoseptal flaps significantly reduced the risk of CSF leakage without compromising nasal quality of life in the long term or mandating additional incisions. Long-term follow-up is important to monitor for late recurrence.

Keywords: Endoscopic endonasal surgery; Endoscopy; Sellar arachnoid cyst; Simple fenestration; Skull base reconstruction.

MeSH terms

Arachnoid Cysts* / diagnostic imaging
Arachnoid Cysts* / surgery
Cerebrospinal Fluid Leak / etiology
Cerebrospinal Fluid Leak / surgery
Endoscopy
Female
Humans
Male
Middle Aged
Quality of Life
Retrospective Studies