title: Transventricular endoscopic fenestration of intrasellar arachnoid cyst.
abstract: BACKGROUND
  To manage arachnoid cysts, incorporation with the normal circulation is the single most important determinant of success. Although the postoperative cerebrospinal fluid leakage rate is 3.9% for all cases of transsphenoidal surgery, it is 21.4% for intrasellar arachnoid cysts.
  
  
  OBJECTIVE
  To present a safe, relatively easy, and effective treatment option for very rare intrasellar arachnoid cysts.
  
  
  METHODS
  We performed a prospective study of intrasellar cystic lesions without a solid portion. Endoscopic exploration and fenestration were performed for all lesions under neuronavigational guidance. We analyzed presenting symptoms, endocrinological status, and magnetic resonance images.
  
  
  RESULTS
  There were 2 male and 4 female patients with a mean age of 45 years (range, 27-67 years). All patients presented with the visual disturbance of bitemporal hemianopsia. Four patients had endocrinological symptoms including galactorrhea, dysmenorrhea, and diabetes insipidus. Endoscopic fenestration of the cyst was successfully performed in all patients. All patients were confirmed to have a pure cystic lesion, namely an arachnoid cyst. The follow-up period was 10 months on average (range, 6-12 months). Visual disturbance improved in 5 patients. Endocrinological problems persisted in all patients for 3 months and then normalized, with the exception of the patient with diabetes insipidus. There was no evidence of recurrence in any of the 6 patients in the 12-month postoperative imaging studies (median follow-up of 10 months). Two patients showed syndrome of inappropriate antidiuretic hormone at 2 and 4 weeks after the operation, but antidiuretic hormones recovered to normal levels after this time point.
  
  
  CONCLUSIONS
  Endoscopic fenestration of an intrasellar arachnoid cyst is a safe and simple procedure without serious complications.
authors.affiliation: Pediatric Neurosurgery, Severance Children's Hospital, Department of Neurosurgery, Brain Korea 21 project for medical science, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Park
authors.forename: Yun-Ho
authors.initials: YH
authors.lastname: Lee
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016080:Arachnoid Cysts / Q000175:diagnosis* / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012658:Sella Turcica / Q000473:pathology* / Q000601:surgery*