Arachnoid diverticula associated with anterior cranial base tumors: technical case report.
BACKGROUND
Cerebrospinal fluid (CSF) diverticula are uncommonly associated with anterior cranial base tumors. When they occur, they often complicate the surgical management of these tumors via a transsphenoidal approach. This report examines the effectiveness of transsphenoidal surgery in the treatment of these rare entities.


METHODS
We performed a review of four sellar and parasellar tumors (three pituitary adenomas and one chordoma) that contained an arachnoid diverticulum communicating with the intracranial subarachnoid space.


RESULTS
One of these tumors (a prolactinoma) was successfully treated medically and regressed dramatically in size; the remaining three were treated by transsphenoidal resection. In all of the operative cases, the tumor was successfully resected with no endocrinological or neurological deficit. An intraoperative CSF leak was encountered in each operative case and was treated by packing the sella with an abdominal fat graft. One patient returned to the operating room for a CSF leak repair. No instances of infection, meningitis, or other major complications occurred. Sellar and parasellar tumors associated with arachnoid diverticula can be successfully treated using transsphenoidal surgery.


CONCLUSIONS
Preoperative anatomic localization of the CSF diverticulum, as well as anticipatory planning for an intraoperative CSF leak are essential. Whenever possible, it is probably wise to preserve the arachnoidocele rather than to rupture it intentionally, obliterating the dead space within the sella in either situation.
Jagannathan
Jay
J
Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA. jj5a@hscmail.mcc.virginia.edu
Okonkwo
David O
DO
Prevedello
Daniel M
DM
Kanter
Adam S
AS
Laws
Edward R
ER
D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D016080:Arachnoid Cysts / Q000150:complications* / Q000601:surgery; D002817:Chordoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome