Transsphenoidal Surgery of Pituitary Cysts

A.V. Polezhaev, V.Yu. Cherebillo, V.R. Gofman

Medicomilitary Academy, Saint Petersburg, Russia

 

Cysts of the pituitary gland and chiasm-sellar area are formed from remnants of epithelial or arachnoid rudiments of Rathke’s recess. They are subdivided into cysts of pars intermedia, Rathke’s recess and colloid, arachnoid, epidermoid, dermoid ones. When there appear such symptoms as headache, visual and hormonal disorders one should consider necessity of surgical treatment.

There were 42 cases with pituitary cysts, operated in the Clinic of Neurosurgery of the Medicomilitary Academy with applying endoscopic transnasal approaches. Endosellar, endoinfrasellar and endosuprasellar localization of cysts was watched in 32.5%, 23.5% and 34.5% of cases, respectively. Giant cysts were present in 9.5% of cases. There were the following types of disorders: visual – 54.2%, hypopituitary – 67.4%, oculomotor – 4% of cases. Common cerebral symptoms were observed in 74% of cases. CT- and MR-examinations demonstrated hypodense or hypointensive formations, which did not enhance in contrast study. They looked like formations of low density, located inside the enhanced pituitary gland. Their contents varied from pure and transparent liquor up to mucoid jellied or viscous greenish-yellow mass. Unlike craniopharyngiomas cysts usually had no petrification signs or solid fragments. Endoscopes with an angular view, varying from 00 up to 700, were used. Operation was completed by plasty of the saddle bottom with Tachocomb. In case of verified liquorrhea it was used together with Bioglue or Tissukol. Postoperative liquorrhea was reveled in 3 cases (7.2%). It was arrested by applying a lumbar drainage and dehydration therapy. All arachnoid and colloid cysts were removed totally. As for big cysts (epidermoid, cholesteatoma), total, subtotal and partial removal was performed in 90.4%, 7.2% and 2.4% of cases, respectively. A relapse rate was 2.4%; visual functions improved in 89.1% of cases.