Skip to main content

Part of the book series: Contemporary Endocrinology ((COE))

Summary

Many lesions that are found within the sella may be cystic in nature. The differential diagnosis for such lesions includes craniopharyngioma, Rathke’s cleft cyst, cystic pituitary adenoma, and arachnoid cyst. This chapter describes the evaluation and management of patients who present with these sometimes troublesome lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Freda PU, Wardlaw SL, Post KD. Unusual causes of sellar/parasellar masses in a large transsphenoidal surgical series. J Clin Endocrinol Metab 1996; 81(10):3455–9.

    Article  PubMed  CAS  Google Scholar 

  2. Harrison MJ, Morgello S, Post KD. Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives? J Neurosurg, 1994; 80(6): 1018–25.

    PubMed  CAS  Google Scholar 

  3. Russell D, Rubinstein L. Pathology of Tumors of the Nervous System, 5th ed. Baltimore: Williams and Wilkins. 1989, pp. 695–702.

    Google Scholar 

  4. Prabhu VC, Brown HG. The pathogenesis of craniopharyngiomas. Childs Nerv Syst 2005;21(8–9):622–7.

    Article  PubMed  Google Scholar 

  5. Sklar CA. Craniopharyngioma: endocrine abnormalities at presentation. Pediatr Neurosurg, 1994;21 Suppl 1:8–20.

    Google Scholar 

  6. Halac I, Zimmerman D. Endocrine manifestations of craniopharyngioma. Childs Nerv Syst 2005; 21(8–9):640–8.

    Article  PubMed  Google Scholar 

  7. Moshang T, Jr Rundle AC, Graves DA, et al. Brain tumor recurrence in children treated with growth hormone: the National Cooperative Growth Study experience. J Pediatr 1996;128(5 Pt 2):S4–7.

    Google Scholar 

  8. Paja M, Garcia-Uria J, Salame F, et al. Hypothalamic-pituitary dysfunction in patients with craniopharyngioma. Clin Endocrinol (Oxf) 1995;42(5): 467–73.

    CAS  Google Scholar 

  9. Banna M, Hoare RD, Stanley P, Till K. Craniopharyngioma in children. J Pediatr 1973;83(5):781–5.

    Article  PubMed  CAS  Google Scholar 

  10. de Vries L, Lazar L, Phillip M. Craniopharyngioma: presentation and endocrine sequelae in 36 children. J Pediatr Endocrinol Metab 2003;16(5):703–10.

    PubMed  Google Scholar 

  11. Isojarvi JI, Turkka J, Pakarinen AJ, et al. Thyroid function in men taking carbamazepine, oxcarbazepine, or valproate for epilepsy. Epilepsia 2001;42(7):930–4.

    Article  PubMed  CAS  Google Scholar 

  12. Curran JG , O’Connor E. Imaging of craniopharyngioma. Childs Nerv Syst 2005;21(8–9):635–9.

    Article  PubMed  Google Scholar 

  13. Hald JK, Eldevik OP, Skalpe IO. Craniopharyngioma identification by CT and MR imaging at 1.5 T. Acta Radiol 1995;36(2):142–7.

    Article  PubMed  CAS  Google Scholar 

  14. Fahlbusch R, et al. Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 1999;90(2):237–50.

    PubMed  CAS  Google Scholar 

  15. Scott RM. Craniopharyngioma: a personal (Boston) experience. Childs Nerv Syst 2005; 21(8–9):773–7.

    Article  PubMed  Google Scholar 

  16. Sainte-Rose, C, Puget S, Wray A, et al. Craniopharyngioma: the pendulum of surgical management. Childs Nerv Syst, 2005;21(8–9): 691–5.

    Article  PubMed  Google Scholar 

  17. Mark RJ, Lutge WR, Shimizu KT, et al. Craniopharyngioma: treatment in the CT and MR imaging era. Radiology 1995;197(1):195–8.

    PubMed  CAS  Google Scholar 

  18. Yasargil MG, Curcic M, Kis M, et al. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 1990;73(1):3–11.

    PubMed  CAS  Google Scholar 

  19. Laws ER, Jr. Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg 1994;21 Suppl 1:57–63.

    Google Scholar 

  20. Kalapurakal JA. Radiation therapy in the management of pediatric craniopharyngiomas – a review. Childs Nerv Syst 2005;21(8–9):808–16.

    Article  PubMed  Google Scholar 

  21. Habrand JL, Ganry O, Couanet D, et al. The role of radiation therapy in the management of craniopharyngioma: a 25-year experience and review of the literature. Int J Radiat Oncol Biol Phys 1999;44(2):255–63.

    PubMed  CAS  Google Scholar 

  22. Tishler RB, Loeffler JL, Lunsford LD, et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993;27(2):215–21.

    PubMed  CAS  Google Scholar 

  23. Amendola BE, Wolf A, Coy SR, et al. Role of radiosurgery in craniopharyngiomas: a preliminary report. Med Pediatr Oncol 2003;41(2):123–7.

    Article  PubMed  Google Scholar 

  24. Chung WY, Pan DHC, Shiau CY, et al. Gamma knife radiosurgery for craniopharyngiomas. J Neurosurg 2000;93 Suppl 3:47–56.

    Google Scholar 

  25. Kalapurakal JA, Kepka A , Bista T, et al. Fractionated stereotactic radiotherapy for pediatric brain tumors: the Chicago children’s experience. Childs Nerv Syst 2000;16(5):296–302, discussion 303.

    Article  PubMed  CAS  Google Scholar 

  26. Loeffler JS, Kooy HM, Tarbell NJ. The emergence of conformal radiotherapy: special implications for pediatric neuro-oncology . Int J Radiat Oncol Biol Phys 1999;44(2):237–8.

    PubMed  CAS  Google Scholar 

  27. DeVile CJ, Grant DB, Hayward RD, et al. Growth and endocrine sequelae of craniopharyngioma. Arch Dis Child 1996;75(2):108–14.

    PubMed  CAS  Google Scholar 

  28. Palm L, Nordin V, Elmqvist D, et al. Sleep and wakefulness after treatment for craniopharyngioma in childhood; influence on the quality and maturation of sleep. Neuropediatrics 1992;23(1):39–45.

    PubMed  CAS  Google Scholar 

  29. Rajan B, Ashley S, Gorman C, et al. Craniopharyngioma: improving outcome by early recognition and treatment of acute complications. Int J Radiat Oncol Biol Phys 1997;37(3):517–21.

    PubMed  CAS  Google Scholar 

  30. Hasegawa T, Kondziolka D, Hadjipanayis CG, et al. Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 2004;54(4):813–20, discussion 820–2.

    Article  PubMed  Google Scholar 

  31. Van den Berge JH, Blaauw G, Breeman WAP, et al. Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg 1992;77(4):545–50.

    PubMed  Google Scholar 

  32. Voges J, Sturm V, Lehrke R, et al. Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources. Neurosurgery 1997;40(2):263–9, discussion 269–70.

    Article  PubMed  CAS  Google Scholar 

  33. Takahashi H, Yamaguchi F, Teramoto A. Long-term outcome and reconsideration of intracystic chemotherapy with bleomycin for craniopharyngioma in children. Childs Nerv Syst 2005;2(8–9):701–4.

    Article  Google Scholar 

  34. Broggi G, Giorgi C, Franzini A, et al. Preliminary results of intracavitary treatment of craniopharyngioma with bleomycin. J Neurosurg Sci 1989;33(1):145–8.

    PubMed  CAS  Google Scholar 

  35. Takahashi H, Nakazawa S, Shimura T. Evaluation of postoperative intratumoral injection of bleomycin for raniopharyngioma in children. J Neurosurg 1985;62(1):120–7.

    PubMed  CAS  Google Scholar 

  36. Mottolese C, Stan H, Hermier M, et al. Intracystic chemotherapy with bleomycin in the treatment of craniopharyngiomas. Childs Nerv Syst 2001;17(12):724–30.

    Article  PubMed  CAS  Google Scholar 

  37. Zanon N. Bleomycin Treatment in Cystic Craniopharyngiomas, in Pediatric Neurosurgery, Choux M, et al. editors. Edinburgh: Churchill Livingstone;1999.

    Google Scholar 

  38. Cavalheiro S, Dastoli PA, Silva NS, et al. Use of interferon alpha in intratumoral chemotherapy for cystic craniopharyngioma. Childs Nerv Syst 2005;21(8–9):719–24.

    Article  PubMed  CAS  Google Scholar 

  39. Chamberlain MC. A phase II trial of intra-cerebrospinal fluid alpha interferon in the treatment of neoplastic meningitis. Cancer 2002;94(10):2675–80.

    Article  PubMed  CAS  Google Scholar 

  40. Teramoto A, Hirikawa K, Sanno N, et al. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 1994;193(1):161–4.

    PubMed  CAS  Google Scholar 

  41. Burger P, Scheithauer B, Vogel F. Surgical Pathology of the Nervous System and Its Coverings, 4th ed. Baltimore: Churchill Livingstone;2002.

    Google Scholar 

  42. Sanno N, Teramoto A, Osamura RY, et al. Pathology of pituitary tumors. Neurosurg Clin N Am 2003;14(1):25–39, vi.

    Article  PubMed  Google Scholar 

  43. el-Mahdy W, Powell M. Transsphenoidal management of 28 symptomatic Rathke’s cleft cysts, with special reference to visual and hormonal recovery. Neurosurgery 1998;42(1):7–16, discussion 16–7.

    Article  PubMed  CAS  Google Scholar 

  44. Isono M, Kamida T, Kobayashi H, et al; Clinical features of symptomatic Rathke’s cleft cyst. Clin Neurol Neurosurg 2001;103(2):96–100.

    Article  PubMed  CAS  Google Scholar 

  45. Matsushima T, Fukui M, Ohta M, et al. Ciliated and goblet cells in craniopharyngioma. Light and electron microscopic studies at surgery and autopsy. Acta Neuropathol (Berl) 1980;50(3):199–205.

    Article  CAS  Google Scholar 

  46. Byun WM, Kim OL, Kim D. MR imaging findings of Rathke’s cleft cysts: significance of intracystic nodules. AJNR Am J Neuroradiol 2000;21(3): 485–8.

    PubMed  CAS  Google Scholar 

  47. Benveniste RJ, King WA, Walsh J, et al. Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg 2004;101(4):577–84.

    PubMed  Google Scholar 

  48. Ross DA, Norman D, Wilson CB. Radiologic characteristics and results of surgical management of Rathke’s cysts in 43 patients. Neurosurgery 1992;30(2):173–8, discussion 178–9.

    Article  PubMed  CAS  Google Scholar 

  49. Midha R, Jay V, Smyth HS. Transsphenoidal management of Rathke’s cleft cysts. A clinicopathological review of 10 cases. Surg Neurol 1991;35(6): 446–54.

    Article  PubMed  CAS  Google Scholar 

  50. Nemoto Y, Inoue Y, Fukuda T, et al. MR appearance of Rathke’s cleft cysts. Neuroradiology 1988;30(2):155–9.

    Article  PubMed  CAS  Google Scholar 

  51. Saeki N. Sunami K, Sugaya Y, et al. MRI findings and clinical manifestations in Rathke’s cleft cyst. Acta Neurochir (Wien) 1999;141(10):1055–61.

    Article  CAS  Google Scholar 

  52. Sumida M, Uozumi T, Mukada K, et al. Rathke cleft cysts: correlation of enhanced MR and surgical findings. AJNR Am J Neuroradiol 1994;15(3):525–32.

    PubMed  CAS  Google Scholar 

  53. Onesti ST, Wisniewski T, Post KD. Pituitary hemorrhage into a Rathke’s cleft cyst. Neurosurgery 1990;27(4):644–6.

    Article  PubMed  CAS  Google Scholar 

  54. Takeichi Y, Nakasu Y, Handa J. MRI of symptomatic Rathke’s cleft cyst: MRI intensity of cyst contents and clinical manifestations . Jpn J Neurosurg 1997;6: 448–55.

    Google Scholar 

  55. Binning MJ, Gottfried ON, Osborn AG, et al. Rathke cleft cyst intracystic nodule: a characteristic magnetic resonance imaging finding. J Neurosurg 2005;103(5):837–40.

    Article  PubMed  Google Scholar 

  56. Kim JE, Kim JH, Kim OL, et al. Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 2004;100(1):33–40.

    Article  PubMed  Google Scholar 

  57. Kleinschmidt-DeMasters BK, Lillehei KO, Stears JC. The pathologic, surgical, and MR spectrum of Rathke cleft cysts. Surg Neurol 1995;44(1):19–26, discussion 26–7.

    Article  PubMed  CAS  Google Scholar 

  58. Shin JL, Asa SL, Woodhouse LJ, et al. Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab 1999;84(11):3972–82.

    Article  PubMed  CAS  Google Scholar 

  59. Aho CJ, Liu C, Zelman V, et al. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 2005;102(2): 189–93.

    PubMed  Google Scholar 

  60. Hsu HY, Piva A, Sadun AA. Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst. Case report. J Neurosurg 2004;100(6):1087–90.

    PubMed  Google Scholar 

  61. Fager CA Carter H. Intrasellar epithelial cysts. J Neurosurg 1966;24(1):77–81.

    PubMed  CAS  Google Scholar 

  62. Sumida M, Migita K, Tominaga A, et al. Concomitant pituitary adenoma and Rathke’s cleft cyst. Neuroradiology 2001;43(9):755–9.

    Article  PubMed  CAS  Google Scholar 

  63. Goyal A, et al. Suprasellar cystic meningioma: unusual presentation and review of the literature. J Clin Neurosci 2002;9(6):702–4.

    Article  PubMed  Google Scholar 

  64. Fortuna A, et al. Cystic meningiomas. Acta Neurochir (Wien) 1988;90 (1–2):23–30.

    Google Scholar 

  65. Kulah A, Ilcayto R, Fiskeci C. Cystic meningiomas. Acta Neurochir (Wien) 1991;111(3–4):108–13.

    Article  CAS  Google Scholar 

  66. Odake G. Cystic meningioma: report of three patients. Neurosurgery 1992;30(6):935–40.

    Article  PubMed  CAS  Google Scholar 

  67. Osborn AG. Handbook of Neuroradiology. St. Louis, MO: Mosby Year Book. 1991. pp. 302–07.

    Google Scholar 

  68. Iqbal J, Kanaan I, Al Homsi M. Non-neoplastic cystic lesions of the sellar region presentation, diagnosis and management of eight cases and review of the literature. Acta Neurochir (Wien) 1999;141(4):389–97, discussion 397–8.

    Google Scholar 

  69. Pierre-Kahn A, Capelle L, Brauner R, et al. Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg 1990;73(3):355–9.

    PubMed  CAS  Google Scholar 

  70. Heier L, et al. Magnetic Resonance Imaging of Arachnoid Cysts. Clin Imaging 1989;4:281–91.

    Article  Google Scholar 

  71. Meyer FB, Carpenter SM, Laws ER Jr. Intrasellar arachnoid cysts . Surg Neurol 1987;28(2):105–10.

    Article  PubMed  CAS  Google Scholar 

  72. Gore RM, Weinberg PE, Kim KS, et al. Sphenoid sinus mucoceles presenting as intracranial masses on computed tomography. Surg Neurol 1980;13(5):375–9.

    PubMed  CAS  Google Scholar 

  73. Yasargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989;24(4):561–7.

    Article  PubMed  CAS  Google Scholar 

  74. McCormick GF, Zee CS, Heiden J, Cysticercosis cerebri. Review of 127 cases. Arch Neurol 1982;39(9):534–9.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Humana Press, Totowa, NJ

About this chapter

Cite this chapter

Snyder, B.J., Naidich, T.P., Post, K.D. (2008). Cystic Lesions of the Sella. In: Swearingen, B., Biller, B.M. (eds) Diagnosis and Management of Pituitary Disorders. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-264-9_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-264-9_23

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-922-2

  • Online ISBN: 978-1-59745-264-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics