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Transventricular Endoscopic Fenestration of Intrasellar Arachnoid Cyst

Shim, Kyu-Won MD, PhD*; Park, Eun-Kyung MD*; Lee, Yun-Ho MD§; Kim, Sun-Ho MD, PhD*,‡; Kim, Dong-Seok MD, PhD*

Neurosurgery:
doi: 10.1227/NEU.0b013e318282a6e3
Research-Human-Clinical Studies
Abstract

BACKGROUND: To manage arachnoid cysts, incorporation with the normal circulation is the single most important determinant of success. Although the postoperative cerebrospinal fluid leakage rate is 3.9% for all cases of transsphenoidal surgery, it is 21.4% for intrasellar arachnoid cysts.

OBJECTIVE: To present a safe, relatively easy, and effective treatment option for very rare intrasellar arachnoid cysts.

METHODS: We performed a prospective study of intrasellar cystic lesions without a solid portion. Endoscopic exploration and fenestration were performed for all lesions under neuronavigational guidance. We analyzed presenting symptoms, endocrinological status, and magnetic resonance images.

RESULTS: There were 2 male and 4 female patients with a mean age of 45 years (range, 27-67 years). All patients presented with the visual disturbance of bitemporal hemianopsia. Four patients had endocrinological symptoms including galactorrhea, dysmenorrhea, and diabetes insipidus. Endoscopic fenestration of the cyst was successfully performed in all patients. All patients were confirmed to have a pure cystic lesion, namely an arachnoid cyst. The follow-up period was 10 months on average (range, 6-12 months). Visual disturbance improved in 5 patients. Endocrinological problems persisted in all patients for 3 months and then normalized, with the exception of the patient with diabetes insipidus. There was no evidence of recurrence in any of the 6 patients in the 12-month postoperative imaging studies (median follow-up of 10 months). Two patients showed syndrome of inappropriate antidiuretic hormone at 2 and 4 weeks after the operation, but antidiuretic hormones recovered to normal levels after this time point.

CONCLUSION: Endoscopic fenestration of an intrasellar arachnoid cyst is a safe and simple procedure without serious complications.

ABBREVIATIONS: IAC, intrasellar arachnoid cyst

SPAC, suprasellar-prepontine arachnoid cyst

Author Information

*Pediatric Neurosurgery, Severance Children's Hospital, Department of Neurosurgery, Brain Korea 21 project for medical science, Yonsei University College of Medicine, Seoul, South Korea

Neuro-oncology, Department of Neurosurgery, Brain Korea 21 project for medical science, Yonsei University College of Medicine, Seoul, South Korea

§National Health Insurance Corporation, Ilsan Hospital, Gayang, South Korea

Correspondence: Dong-Seok Kim, MD, PhD, Professor, Pediatric Neurosurgery, Severance Children's Hospital, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea. E-mail: dskim33@yuhs.ac

Received August 4, 2012

Accepted November 27, 2012

Copyright © by the Congress of Neurological Surgeons