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Transventricular Endoscopic Fenestration of Intrasellar Arachnoid Cyst

 Kyu-Won Shim  ;  Eun-Kyung Park  ;  Yun-Ho Lee  ;  Sun-Ho Kim  ;  Dong-Seok Kim 
 NEUROSURGERY, Vol.72(4) : 520-528, 2013 
Journal Title
Issue Date
Adult ; Aged ; Arachnoid Cysts/diagnosis* ; Arachnoid Cysts/surgery* ; Cerebral Ventricles/pathology ; Cerebral Ventricles/surgery* ; Endoscopy/methods* ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sella Turcica/pathology* ; Sella Turcica/surgery*
Arachnoid cyst ; Endoscope ; Intrasellar
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.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Seok(김동석)
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Park, Eun Kyung(박은경)
Shim, Kyu Won(심규원) ORCID logo https://orcid.org/0000-0002-9441-7354
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