In some cases, variable postoperative complications can be caused by the operative techniques in suprasellar arachnoid cyst.

The endocrine dysfunction can occur in about 40% of cases that were managed surgically. This complication was reported to be caused by intraoperative injury of hypothalamus, pituitary apparatus and peripituitary vasculature ¹⁾.

Neurosurgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae ²⁾.

Hyponatremia as a result of cerebral salt wasting ³⁾.

A transient endocrine complication, which is electrolyte imbalance such as hyponatremia, can resolve in several days. This transient complication can be caused by intraoperative irrigation with normal saline and transient stretch of the hypothalamus by tugging at the cyst during fenestration, without significant structural injury ^{4) 5)}.

Extrapontine myelinolysis of osmotic demyelination syndrome ⁶⁾.

CSF Leak ⁷⁾.

A 49-year-old man presented with episodes of altered mental status. He had two surgeries for a recurrent suprasellar arachnoid cyst. The second surgery was complicated by a persistent cerebrospinal fluid (CSF) leak that required two repairs following which he developed panhypopituitarism and central diabetes insipidus. Twelve months after his last surgery he was diagnosed with aseptic meningitis. This was followed by recurrent hospitalisations for severe hypernatremia blamed on poor medication compliance. He was subsequently hospitalised for the evaluation of a febrile illness. Brain MRI showed ventriculitis and enhancement of the sella. Exploratory surgery revealed a purulent collection in the sella and a mucosal graft which had been used to repair the CSF leak. After drainage of pus and replacement of the graft he recovered completely but requiring life-long hormonal replacement. CSF leak ⁸⁾

Spontaneous Intracystic Hemorrhage ⁹⁾.