Pituitary adenoma coexisting with a suprasellar arachnoid cyst.

OBJECTIVE: Biochemical and radiological properties of sellar and parasellar lesions are quite similar in some instances. This leads to a difficulty in preoperative diagnosis. Here, a pituitary adenoma and a suprasellar arachnoid cyst in the same patient is presented, and possible etiopathogenetic mechanisms and surgical treatment are discussed. CASE: A 56-year-old male patient was admitted to the hospital with a history of seizures, urinary incontinence and visual disturbances. Preoperative MRI revealed a mass lesion in the sella turcica with suprasellar extension and a coexisting large supra- and parasellar cyst. DISCUSSION AND CONCLUSION: A slow-growing mass lesion beneath the defective mesencephalic leaf of the Liliequist membrane may lead to a one-way valve system on its surface. It might be speculated that CSF will become trapped in the cyst during tumor growth. The other possible mechanism to explain the coexistence is discussed. In light of these comments and intraoperative observations, we suggest a third type of suprasellar arachnoid cyst. a semi-communicative type.

Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience.

We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.