This month the PNA Medical Corner features an article co-written by PNA cofounder Dr. Shereen Ezzat. The study looks at the use of endonasal endoscopic surgery to remove sellar arachnoid cysts and finds a simple cyst-opening technique and skull base reconstruction utilizing nasoseptal flaps can decrease the likelihood of a cerebrospinal fluid leak.
Link: https://pubmed.ncbi.nlm.nih.gov/35217229/
World Neurosurg
.2022 Feb 22
doi: 10.1016/j.wneu.2022.02.072. Online ahead of print.
Endoscopic treatment of sellar arachnoid cysts via a simple cyst-opening technique: Long-term outcomes from a single center
Aristotelis Kalyvas 1, Matthias Milesi 2, Matheus Leite 3, Kaiyun Yang 3, Leslie St Jacques 3, Allan Vescan 4, Ozgur Mete 5, Shereen Ezzat 6, Gelareh Zadeh 3, Fred Gentili 3
Affiliations expand
• 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 utilized. Despite their simple cystic appearance and the straight-forward surgical intervention there are important associated risks, with CSF leak being the prevalent one.
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 utilizing nasoseptal flaps was used.
Results: Ten patients were identified (7 female and 3 male, median age was 54.5 years, range 20-77); 8 had newly diagnosed SACs whereas 2 recurrences from a previously microsurgically fenestrated SAC. Eight patients presented with visual symptoms (VS), 1 with VS and fatigue, and 1 with headaches. Neuro-ophthalmological and endocrinological assessments revealed visual field (VF) deficits in 6, visual acuity (VA) decline in 5 and hypopituitarism in 2 patients. Median calculated volume was 1.71 ml (range 0.27 – 2.54 ml). Postoperatively, no CSF leak and no further surgical complications were noted. VF improved in 4/6 while VA improved in 4/5 patients. Anterior pituitary function improved in 1, worsened in 1 and remained stable in 8 patients. One patient suffered diabetes insipidus. One recurrence was recorded 54 months postoperatively.
Conclusion: SACs can be effectively treated with a simple cyst-opening technique. The routine use of nasoseptal flaps significantly reduces the risk of CSF leak without compromising nasal quality of life in the long-term or mandating additional incisions. A long-term follow-up is important to monitor for late recurrences.
Keywords: Sellar arachnoid cyst; endoscopic endonasal surgery; endoscopy; simple fenestration; skull base reconstruction.
