Cisto Aracnoide Intrasselar Tratado por via Endoscópica Endonasal

Arachnoid cysts (AC) represent 1% of intracranial masses, and the intrasellar location occurs in only 3% of these cysts. Because it is a rare pathology with more common differential diagnoses (pituitary adenoma, craniopharyngioma, Rathke’s pouch cyst), its management still raises doubts. Case report: 53 year-old patient with complaints of visual scotomas, holocranial headache, vertigo and visual and auditory hallucinations. Magnetic resonance imaging (MRI) of the brain showed cystic lesion in the topography of the sella turcica with compression of the optic pathways. The patient was submitted to an endoscopic transsphenoidal surgery. After cyst fenestration, a communication between the cyst and the suprasellar subarachnoid space was observed. The cyst was obliterated with fat and the reconstruction included a pedicled nasoseptal flap. The patient did not present cerebrospinal fluid leak (CSF) in the postoperative period. There was a significant improvement in headache and visual changes. The control MRI showed regression of the compression on the optical pathways. Discussion: Symptomatic intrasellar AC requires surgical management. The treatment can be performed through transcranial and transsphenoidal approaches. The endonasal endoscopic approach is the most commonly used nowadays. There is still debate about the best option to address these lesions. Removal of the entire cyst is possible, but increases the manipulation of the pituitary gland and the risk of hormonal dysfunction. Another option is to open the cyst and obliterate it with fat, with minimal manipulation of the pituitary gland and lower risk of CSF leak. We present a case treated with obliteration of the cyst with a satisfactory outcome.