Reference : Intrasellar arachnoid cysts.
Scientific journals : Article
Human health sciences : Neurology
Human health sciences : Surgery
http://hdl.handle.net/2268/4779
Intrasellar arachnoid cysts.
English
Dubuisson, Annie mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Stevenaert, Achille [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Martin, Didier mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Flandroy, Pierre P [> > > >]
2007
Neurosurgery
Lippincott Williams & Wilkins
61
3
505-13; discussion 513
Yes (verified by ORBi)
International
0148-396X
1524-4040
Hagerstown
MD
[en] Adult ; Aged ; Aged, 80 and over ; Arachnoid Cysts/diagnosis/radiography/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Sella Turcica/radiography/surgery
[en] OBJECTIVE: To evaluate the clinical, endocrinological, and radiological presentation of nine cases of surgically verified intrasellar arachnoid cysts and to discuss the physiopathological mechanisms of formation of these cysts. METHODS: Among 1540 patients presenting with pituitary lesions, nine presented with an intrasellar arachnoid cyst. Their charts were retrospectively reviewed. RESULTS: Presenting symptoms included headache (n = 2), visual symptoms (n = 3), menstrual irregularities (n = 2), rapid weight gain (n = 1), vertigo (n = 1), and/or confusion (n = 1). Two cysts were discovered incidentally. T1-weighted magnetic resonance imaging scans showed an intrasellar cystic lesion in all cases, with a huge suprasellar extension in six cases. The cyst was of the same intensity as the cerebrospinal fluid (CSF) in only two patients. A transsphenoidal approach allowed the transdural aspiration of fluid and injection of a water-soluble contrast agent under mild pressure. In three patients, the contrast infiltrated along the pituitary stalk toward the subarachnoid spaces; in the other patients, it remained in the intrasellar compartment. Cyst membranes were removed as completely as possible with fenestration toward the subarachnoid spaces in communicating cysts. In spite of tight packing of the sella and sphenoid sinus, CSF fistulae requiring reoperation developed in two patients. CONCLUSION: The clinical picture of an intrasellar arachnoid cyst resembles that of a nonfunctional pituitary adenoma. Magnetic resonance imaging scans typically show a cystic intrasellar lesion with suprasellar extension, containing isointense or, more often, hyperintense fluid on T1-weighted sequences. In spite of the risk of CSF fistulae, the preferred surgical approach is transsphenoidal. A physiopathological mechanism is proposed according to anatomic variations of the sellar diaphragma allowing penetration of subarachnoid spaces into the sellar compartment and their enlargement by a ball-valve mechanism.
http://hdl.handle.net/2268/4779
10.1227/01.NEU.0000290896.69825.40

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