Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts

• D’artigues Jean
• Graillon Thomas
• Boissonneau Sébastien
• Farah Kaissar
• Amodru Vincent
• Brue Thierry
• Fuentes Stéphane
• Dufour Henry

• Intrasellar cyst
• Endoscopic surgery
• Cyst obliteration
• Endonasal approach
• Skull base
• Arachnoid cysts

Purpose To report our experience of endoscopic endonasal obliteration of symptomatic sellar arachnoid cyst (SAC). Methods From 2002 to 2019, we retrospectively reported the data of 17 cases of SAC operated in Timone University Hospital, Marseille, France. Preoperative clinical findings were collected including main symptoms, visual function and endocrinological assessment. Surgical procedure was homogeneous and consisted in endonasal fully endoscopic surgical obliteration of the cyst cavity with fat graft. Post-operative outcomes, complication and follow-up was reported. Results Visual disorders and/or headaches were the main symptoms. Our technique provided improvement for 83.3% of the patients suffering from visual disturbance and for 87.5% of those suffering from headaches. We reported 2 cases of cerebrospinal fluid (CSF) leakage (11.8%), but no meningitis. One case of definitive diabetes insipidus occurred and one case of postoperative syndrome of inappropriate antidiuretic hormone secretion was temporary. There was one case of recurrence reported. The mean follow-up was 39 months. Conclusion Patients with symptomatic SAC can be treated successfully by endoscopic endonasal obliteration of the cyst. This simple technique offers true benefits for the patients without craniotomy, but the complication rate remains high especially with the risk of CSF leakage. Special attention to skull base opening and closing could reduce this risk.