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Endoscopic transsphenoidal cisternostomy for nonneoplastic sellar cysts.

Su Y, Ishii Y, Lin CM, Tahara S, Teramoto A, Morita A - Biomed Res Int (2015)

Bottom Line: However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant.Conclusion.We report this technique and discuss the benefit of this minimally invasive approach.

View Article: PubMed Central - PubMed

Affiliation: Comprehensive Cancer Center of Taipei Medical University and Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.

ABSTRACT
Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant. Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke's cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable. Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.

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Mentions: After performing a wide sphenoidotomy and sellar floor opening (Figure 1(a)), the dura was incised horizontally (Figure 1(b)). The content of the RCCs was removed using suction and irrigation. The cyst wall was then inspected by inserting an endoscope at 0°, 30°, and 70° angles. In addition, the subarachnoid membrane, pituitary stalk, and the dorsum sellae were identified (Figure 1(c)). The bilateral anterior communicating arteries and optic chiasm were also clearly observed (Figure 2). The cyst wall was biopsied and sent for pathology exam. Fenestration of the subarachnoid space in the cystic wall was performed using bipolar coagulation and sharp scissors (Figure 1(d)). This step was performed carefully to avoid injuring the basilar artery behind the arachnoid membrane. The posterior communicating artery was identified after the fenestration (Figure 3). The cyst wall was not removed from the pituitary gland because of the risk of worsening the pituitary function. After communication with the subarachnoid space, the dura was closed with interrupted sutures using 6-0 nylon and the easy slipknot technique (Figures 1(e) and 1(f)) [8]. No fat or other grafts were used for packing the cyst cavity. The sellar floor was reconstructed using an autologous sellar bone, a nasal septum bone, or artificial absorbable plate. Fibrin glue was then applied to the surgical field and the nostril was packed with gauze. No nasal septal flap, lumbar drain, or acetazolamide was used.


Endoscopic transsphenoidal cisternostomy for nonneoplastic sellar cysts.

Su Y, Ishii Y, Lin CM, Tahara S, Teramoto A, Morita A - Biomed Res Int (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4317582&req=5

Mentions: After performing a wide sphenoidotomy and sellar floor opening (Figure 1(a)), the dura was incised horizontally (Figure 1(b)). The content of the RCCs was removed using suction and irrigation. The cyst wall was then inspected by inserting an endoscope at 0°, 30°, and 70° angles. In addition, the subarachnoid membrane, pituitary stalk, and the dorsum sellae were identified (Figure 1(c)). The bilateral anterior communicating arteries and optic chiasm were also clearly observed (Figure 2). The cyst wall was biopsied and sent for pathology exam. Fenestration of the subarachnoid space in the cystic wall was performed using bipolar coagulation and sharp scissors (Figure 1(d)). This step was performed carefully to avoid injuring the basilar artery behind the arachnoid membrane. The posterior communicating artery was identified after the fenestration (Figure 3). The cyst wall was not removed from the pituitary gland because of the risk of worsening the pituitary function. After communication with the subarachnoid space, the dura was closed with interrupted sutures using 6-0 nylon and the easy slipknot technique (Figures 1(e) and 1(f)) [8]. No fat or other grafts were used for packing the cyst cavity. The sellar floor was reconstructed using an autologous sellar bone, a nasal septum bone, or artificial absorbable plate. Fibrin glue was then applied to the surgical field and the nostril was packed with gauze. No nasal septal flap, lumbar drain, or acetazolamide was used.

Bottom Line: However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant.Conclusion.We report this technique and discuss the benefit of this minimally invasive approach.

View Article: PubMed Central - PubMed

Affiliation: Comprehensive Cancer Center of Taipei Medical University and Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.

ABSTRACT
Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant. Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke's cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable. Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.

Show MeSH
Related in: MedlinePlus