suprasellar_arachnoid_cyst

Suprasellar arachnoid cyst

J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Suprasellar arachnoid cyst is a type of intracranial arachnoid cyst.

They differ from other arachnoid cysts in several ways, making a separate analysis of these cysts worthwhile.

The sellar region can be affected by a variety of non-pituitary cystic lesions, including craniopharyngiomas, Rathke’s cleft cysts, and arachnoid cyst 1).

Such lesions represent only 5.5% of all sellar lesions, with arachnoid cyst comprising up to 20% of them 2) 3)

Sellar arachnoid cyst is therefore rare, representing only 0.6 to 0.8% of all sellar lesions 4) 5).

In adults suprasellar cysts represent 9% of all the arachnoid cysts while in pediatric population this percentage reaches 15%. 6).

Suprasellar arachnoid cyst classification

Suprasellar arachnoid cyst pathophysiology.

Although their true histological nature is rarely known because their membranes are not often analyzed histologically, it is reasonable to think that the majority are arachnoid cysts.

Suprasellar arachnoid cyst clinical features.

MRI reveal cerebrospinal fluid (CSF) intensity on both T1- and T2-weighted images 7).

As with arachnoid cysts elsewhere, they are very thin walled (often imperceptible except on dedicated high resolution T2 imaging) cystic lesions which follow CSF on all imaging modalities. There is no solid component and no enhancement.

These cysts invaginate superiorly into the third ventricle, and may even extend into one or both foramen of Monro.

Suprasellar arachnoid cyst differential diagnosis

see Suprasellar arachnoid cyst treatment.

Suprasellar arachnoid cyst outcome.

Suprasellar arachnoid cyst case series.

Suprasellar arachnoid cyst case reports.

A case of a 2-year-old boy who presented with instability and episodes of ocular deviation. A computed tomography scan (CT scan) and magnetic resonance imaging (MRI) of the brain revealed a suprasellar cyst and obstructive hydrocephalus. At birth a transfontanellar ultrasound was normal. The cyst underwent endoscopic fenestration with complete remission of symptoms. In the review of the literature, Gelabert-González et al. found only 6 previous cases of an intracranial arachnoid cyst whose origin was not clearly congenital or traumatic, and Gelabert-González et al. is the second case of a suprasellar arachnoid cyst to arise de novo 8)

A 4-year-old child who was incidentally found to have a suprasellar arachnoid cyst (SAC) after initial CT imaging at 6 weeks of age but who demonstrated no anomalies. This is only the sixth case of intracranial de novo ACs documented in the English literature and only the second case of SAC to arise de novo.

With the use of fast MRI scans instead of CT scans and the continued neuroimaging of premature infants, we can take a better look at the anatomy and better determine the timing of development of the SAC 9)


1)
Zada G, Lin N, Ojerholm E, Ramkissoon S, Laws ER. Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships. Neurosurg Focus. 2010 Apr;28(4):E4. doi: 10.3171/2010.2.FOCUS09318. Review. PubMed PMID: 20367361.
2) , 4)
Valassi E, Biller BM, Klibanski A, Swearingen B. Clinical features of nonpituitary sellar lesions in a large surgical series. Clin Endocrinol (Oxf). 2010;73(6):798-807.
3)
Cavallo LM, Prevedello D, Esposito F, Laws ER Jr, Dusick JR, Messina A, et al. The role of the endoscope in the transsphenoidal management of cystic lesions of the sellar region. Neurosurg Rev. 2008;31(1):55-64; discussion 64.
5)
Dubuisson AS, Stevenaert A, Martin DH, Flandroy PP. Intrasellar arachnoid cysts. Neurosurgery. 2007;61(3):505-13; discussion 513.
6)
Hinojosa J, Esparza J, Muñoz MJ, Valencia J. [Endoscopic treatment of suprasellar arachnoid cysts]. Neurocirugia (Astur). 2001 Dec;12(6):482-8; discussion 489. Review. Spanish. PubMed PMID: 11787396.
7)
Oyama K, Fukuhara N, Taguchi M, Takeshita A, Takeuchi Y, Yamada S. Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note. Neurosurg Rev. 2014 Apr;37(2):261-7; discussion 267. doi: 10.1007/s10143-013-0496-4. Epub 2013 Sep 3. PubMed PMID: 23999887.
8)
Gelabert-González M, Pita-Buezas L, Santín-Amo JM, Román-Pena P, Serramito-García R, García-Allut A. [«De novo» development of a suprasellar arachnoid cyst]. Neurocirugia (Astur). 2015 Mar-Apr;26(2):100-4. doi: 10.1016/j.neucir.2014.09.007. Epub 2015 Feb 2. Spanish. PubMed PMID: 25656308.
9)
Invergo D, Tomita T. De novo suprasellar arachnoid cyst: case report and review of the literature. Pediatr Neurosurg. 2012;48(3):199-203. doi: 10.1159/000345636. Epub 2013 Feb 13. Review. PubMed PMID: 23407142.
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