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Intracranial Arachnoid Cysts

DEB/NICHD/NIH National Institutes of Health Bethesda, Maryland 20892-1862

We would like to congratulate Shin et al. (1) on their recent study on patients with cystic lesions of the pituitary. Among these patients were five with sellar arachnoid cysts (ACs). Symptoms of these five patients consisted mostly of headaches (three patients). None had epileptic seizures. The only endocrinological problems were decreased libido (two patients), hypogonadism (one patient), and hypocortisolism (three patients). Three of the five patients had visual field defects. Postoperatively, the endocrinological abnormalities and visual field defects disappeared. We would like to add our experience with intracranial ACs. Of 44 patients with intracranial ACs, 3 patients had a sellar AC (2). None of these three patients had headaches, whereas in most of our patients with intracranial ACs, headaches occurred with a temporal cyst location. One child had precocious puberty, probably unrelated to the sellar AC. We did not operate on the three patients with a sellar AC. On more than 3 yr follow-up, they remained clinically stable. None of our patients with sellar ACs and none of the patients reported by Shin et al. (1) had epileptic seizures. In contrast, a literature review (3) revealed that several patients with sellar ACs had so-called diencephalic epilepsy, a term coined by Penfield (4) and very controversial from the view of an epileptologist these days. In our experience, patients with sellar ACs should be treated medically in the absence of visual field defects and/or increased intracranial pressure (e.g. by hydrocephalus).

Footnotes

Address correspondence to: Christian A. Koch, DEB/NICHD/NIH, National Institutes of Health, Building 10, Room 10N262, 10 Center Drive, MSC 1862, Bethesda, Maryland 20892-1862.

Address correspondence to: Shereen Ezzat, Division of Endocrinology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 429, Toronto, Ontario M5G 1X5, Canada.

Received December 3, 1999.

References

1. Shin JL, Asa SL, Woodhouse LJ, Smyth HS, Ezzat S. 1999 Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab. 84:3972–3982.[Abstract/Free Full Text]
2. Koch CA, Voth D, Kraemer G, Schwarz M. 1995 Arachnoid cysts: does surgery improve epileptic seizures and headaches? Neurosurg Rev. 18:173–181.[CrossRef][Medline]
3. Koch CA, Moore JL, Voth D. 1998 Arachnoid cysts: how do postsurgical cyst size and seizure outcome correlate? Neurosurg Rev. 21:14–22.[CrossRef][Medline]
4. Penfield W. 1929 Diencephalic epilepsy. Arch Neurol Psychiatry. 22:358–374.[Abstract/Free Full Text]

Authors’ Response

University of Toronto Toronto, Ontario M5G 1X5, Canada

We would like to offer the following reply with respect to the letter of Drs. Koch and Pacek.

We thank Drs. Koch and Pacek for sharing their experience with patients harboring arachnoid cysts (ACs). It is especially pertinent that unlike patients with other intracranial ACs or those with RCC or craniopharyngiomas, those with sellar ACs seem to be less vulnerable to progressive endocrine or neurologic dysfunction. Thus, we would agree that patients with sellar ACs may be managed medically provided there is no evidence of visual defects and/or increased intracranial pressure.

Received December 15, 1999.

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