Endoscopic transsphenoidal fenestration of symptomatic sellar arachnoid cyst: Early experience from Zagazig University

Abstract

ABSTRACT Objective Sellar arachnoid cysts (SACs) are rare lesions that may cause headache, visual impairment, and endocrine dysfunction due to compression of adjacent structures. We report our early experience with endoscopic transsphenoidal fenestration and cyst obliteration for symptomatic SACs. Materials and Methods A retrospective review was conducted of nine patients (5 females, 4 males; the median age was 32 years (IQR, 25–35 years; range, 19–42 years) who underwent endoscopic transsphenoidal surgery for symptomatic SACs between 2018 and 2025. Preoperative evaluation included clinical assessment, ophthalmologic examination, hormonal profiling, and magnetic resonance imaging (MRI). Surgical management consisted of cyst fenestration, decompression, and multilayer skull base reconstruction using autologous fat grafts and fascia. Clinical, radiological, and endocrine outcomes were assessed during follow-up. Results Headache (77.8%) and visual impairment (66.7%) were the most common symptoms. Postoperatively, headache, vision, and endocrine function improved in 85.7%, 83.3%, and 80% of affected patients, respectively. The median preoperative cyst volume was 37.5 cm 3 (IQR, 34.5–43.0 cm 3 ), which decreased to a median postoperative residual cavity volume of 15.0 cm 3 (IQR, 12.0–16.0 cm 3 ). Two patients developed transient diabetes insipidus with complete recovery. No cerebrospinal fluid leakage, recurrence, reoperation, or mortality occurred during follow-up. Conclusion Endoscopic transsphenoidal fenestration with cyst obliteration appears to be a safe and effective treatment option for symptomatic SACs, providing favorable clinical and radiological outcomes with low morbidity.