Neurology India
September 4, 2026 · via Europe PMC
Surgical Experience and Literature Review of Sellar and Suprasellar Arachnoid Cysts: Endoscopic Management and Surgical Anatomy-Based Reorganization.
Kanala RR, Rangan VS, Amarendra P, Yerragunta T, Bhattacharjee S, Yerramneni VK.
AI summary — for doctors, generated from the abstract only
In a small single-center series, endoscopic surgery relieved symptoms in all 10 patients with sellar/suprasellar arachnoid cysts without CSF leak or recurrence, and the authors propose a new anatomy-based classification to guide surgical approach.
What was studied
A retrospective review of 10 cases of sellar/suprasellar arachnoid cysts (SAC) managed endoscopically at one institution over 5 years, combined with a literature review of studies published after 2010 describing endoscopic management of 6 or more SAC cases.
Key findings
- All 10 cases underwent endoscopic cyst fenestration with wall biopsy; wide cysto-cisternostomy was performed in all large suprasellar cysts.
- All patients had symptom relief postoperatively, with no CSF leaks or recurrence noted at last follow-up (duration not specified in the abstract).
- The authors propose classifying these cysts into intrasellar, sellar-suprasellar, and premesencephalic/prepontine types based on cisternal location to guide approach selection.
- The literature review found inconsistent nomenclature across studies but generally successful endoscopic outcomes.
Clinical relevance
The findings suggest that endoscopic management, with approach chosen according to cyst location (endonasal vs. transventricular), may be safe and effective for sellar/suprasellar arachnoid cysts, though this is based on a very small single-center series.
Who should care
Limitations
The primary series included only 10 patients at a single institution, with a retrospective design and follow-up duration not specified in the abstract.
In 10 patients, endoscopic surgery for sellar/suprasellar arachnoid cysts relieved symptoms with no leaks or recurrence, supporting a new anatomy-based classification system.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
The suprasellar cistern containing major neurovascular structures is accessible by various microscopic and endoscopic approaches. While literature strengthening the case for skull-base endoscopic management of neoplastic sellar-suprasellar lesions abounds, a straightforward algorithm for endoscopically managing sellar/suprasellar arachnoid cysts (SAC) has not been set forth. This is likely due to their low incidence and the wide variation in both nomenclature and surgical management described in the literature.
Methods
All (10) cases of SAC managed at our institution over the past 5 years have been analyzed and included in this retrospective study. All cases underwent endoscopic surgery as deemed appropriate by the managing teams. All studies published after 2010 describing endoscopic management of six or more SAC cases were reviewed.
Results
Endoscopic fenestration of the cyst with wall biopsy was done in all cases. Wide cysto-cisternostomy was done in all large suprasellar cysts. This was performed via the endonasal route in cases with a large(r) sellar + suprasellar component (anterior to the dorsum sellae) or via transventricular endoscopy in cases with a large(r) premesencephalic/prepontine (retrosellar) component. Postoperatively, all patients in our series experienced relief of symptoms with no complicating CSF leaks or evidence of recurrence at last follow-up. Literature review revealed gross inconsistencies in the nomenclature of each cyst type while largely describing successful endoscopic management. We encountered three main types of cysts and found that the most useful method of grouping SACs to aid surgical approach selection is based on their predominant cisternal location. Therefore, we suggest that they be organized into the intrasellar, sellar-suprasellar, and premesencephalic/prepontine types.
Conclusion
Reorganizing SACs based on their anatomical extent simplifies academic communication and aids in choosing the surgical approach. In our experience treating these rare cysts, transventricular as well as transnasal endoscopic surgery has proven safe and efficient.
DOI
10.4103/neurol-india.neurol-india-d-25-00819
PMID
42700139
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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