• Aristotelis Kalyvas, Matthias Milesi, Matheus Leite, Kaiyun Yang, St JacquesLeslieLDivision of Neurosurgery, Department of Surgery, University Health Network/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada., Allan Vescan, Ozgur Mete, Shereen Ezzat, Gelareh Zadeh, and Fred Gentili.
• Division of Neurosurgery, Department of Surgery, University Health Network/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: aristoteliskalyvas@gmail.com.
• World Neurosurg. 2022 May 1; 161: e625-e634.

BackgroundSellar arachnoid cysts (SACs) are rare lesions that require treatment only if symptomatic. The endoscopic endonasal approach has been widely used. Despite their simple cystic appearance and the straight-forward surgical intervention, important associated risks exist, with cerebrospinal fluid (CSF) leak the prevalent risk.MethodsA retrospective analysis of patients with pathologically confirmed SAC between January 2006 and December 2019 was conducted. A homogeneous simple cyst-opening technique and skull base reconstruction with nasoseptal flaps was used.ResultsA total of 10 patients were identified (7 women and 3 men; median age, 54.5 years; range, 20-77 years). Of the 10 patients, 8 had had newly diagnosed SACs and 2 patients had had recurrence from a previously microsurgically fenestrated SAC. Eight patients had presented with visual symptoms, one with visual symptoms and fatigue, and one with intractable headaches. Neuro-ophthalmological and endocrinological assessments had revealed visual field deficits in 6, visual acuity decline in 5, and hypopituitarism in 2 patients. The median calculated volume was 1.71 mL (range, 0.27-2.54 mL). Postoperatively, no CSF leak and no further surgical complications were noted. The visual field had improved in 4 of 6 patients and visual acuity had improved in 4 of 5 patients. Anterior pituitary function had improved in 1, worsened in 1, and remained stable in 8 patients. One patient had developed diabetes insipidus. One recurrence was recorded at 54 months postoperatively.ConclusionsThe results from the present study have shown that SACs can be effectively treated using a simple cyst-opening technique. The routine use of nasoseptal flaps significantly reduced the risk of CSF leakage without compromising nasal quality of life in the long term or mandating additional incisions. Long-term follow-up is important to monitor for late recurrence.Copyright © 2022 Elsevier Inc. All rights reserved.

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