Suprasellar arachnoid cyst [Neurosurgery Wiki]

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====== Suprasellar arachnoid cyst ======
//J.Sales-Llopis//

//Neurosurgery Department, University General Hospital of Alicante, Spain//
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[[Suprasellar]] [[arachnoid cyst]] is a type of [[intracranial arachnoid cyst]].

They differ from other [[arachnoid cyst]]s in several ways, making a separate analysis of these [[cyst]]s worthwhile.


===== Videos =====
Rychen J, Constanzo F, Chan D, Kossler AL, Fernandez-Miranda JC. Anatomic and Surgical Considerations in the Management of a Sellar and Suprasellar Arachnoid Cyst: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2024 Jan 9. doi: 10.1227/ons.0000000000001061. Epub ahead of print. PMID: 38198191.

===== Epidemiology =====

The [[sellar region]] can be affected by a variety of non-pituitary cystic lesions, including [[craniopharyngioma]]s, [[Rathke’s cleft cyst]]s, and [[arachnoid cyst]]
((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.
)).

Such lesions represent only 5.5% of all [[sellar lesion]]s, with arachnoid cyst comprising up to 20% of them
((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.))
((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.))

Sellar arachnoid cyst is therefore rare, representing only 0.6 to 0.8% of all sellar lesions
((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.))
(( Dubuisson AS, Stevenaert A, Martin DH, Flandroy PP. Intrasellar arachnoid cysts. Neurosurgery. 2007;61(3):505-13; discussion 513.)).

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

===== Classification =====

[[Suprasellar arachnoid cyst classification]]

===== Pathophysiology =====

[[Suprasellar arachnoid cyst pathophysiology]].


====Histology====
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.
===== Clinical Features =====

[[Suprasellar arachnoid cyst clinical features]].

====Diagnosis====
[[MRI]] reveal [[cerebrospinal fluid]] (CSF) intensity on both [[T1]]- and [[T2]]-weighted images
((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.)).

{{::suprasellar_arachnoid_cyst.jpg?400|}}

As with [[arachnoid cyst]]s 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]]. 
===== Differential diagnosis =====

[[Suprasellar arachnoid cyst differential diagnosis]]

===== Treatment =====

see [[Suprasellar arachnoid cyst treatment]].


===== Outcome =====

[[Suprasellar arachnoid cyst outcome]].

===== Case series =====

[[Suprasellar arachnoid cyst case series]].

===== Case reports =====

[[Suprasellar arachnoid cyst case reports]].

=====De novo suprasellar arachnoid cyst=====
====2015====
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
((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.))

====2012====
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
((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.))

====References====