title: [Therapeutic strategy for intrasellar cystic lesions].
abstract: OBJECTIVE
  To make a clear distinction of intrasellar cystic lesions: craniopharyngioma (CR), Rathke's cleft cyst (RCC), cystic pituitary adenoma (PA) and intrasellar arachnoid cyst (AC).
  
  
  METHODS
  A total of 72 adult patients underwent transsphenoidal approach for the removal of intrasellar cystic lesions. The authors conducted a study to (1) investigate preoperative clinical, biochemical and radiographic features of patients with CR, RCC, PA and AC; (2) identify clinicopathological features of independently predicting recurrence in CR, PA and RCC in adults. These adult patients included CR (n = 10), RCC (n = 27), cystic PA (n = 32) and 1 patient with AC (n = 1).
  
  
  RESULTS
  The CR patients presented with hypopituitarism in 80% of cases. According to the biochemical criteria, the percentage of patients with a slight prolactin increase happened in PA (55.6%) and RCC (44.4%). Cystic PA had post-contrasting enhancement in cyst wall because of tumor tissue. Calcification detectable on computed tomographic scanning was present in 70% of CR patients. It was a significantly greater proportion compared to other diseases. Typical RCC was located between anterior and posterior pituitary and the contents in RCC were variable. Mass effects vanished post-operatively in all kinds of lesions. Long-term hormone replacement therapy was administered more in CR patients (60%) and diabetes insipidus than other lesions. One PA patient and 2 CR patients had recurrence during a follow-up of 12 - 52 months (mean: 34). RCC and AC had no recurrence.
  
  
  CONCLUSIONS
  Craniopharyngioma, Rathke's cleft cyst, cystic pituitary adenoma and intrasellar arachnoid cyst are a spectrum of diseases with different therapeutic strategies. An accurate diagnosis of these lesions is essential so as to determine the type of treatment to improve outcome.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Wei-ming
authors.initials: WM
authors.lastname: Liu
authors.forename: Ming
authors.initials: M
authors.lastname: Ni
authors.forename: Wang
authors.initials: W
authors.lastname: Jia
authors.forename: Shu-sen
authors.initials: SS
authors.lastname: Guan
authors.forename: Gui-jun
authors.initials: GJ
authors.lastname: Jia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016080:Arachnoid Cysts / Q000145:classification / Q000601:surgery*; D020863:Central Nervous System Cysts / Q000145:classification / Q000601:surgery; D003397:Craniopharyngioma / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D055815:Young Adult