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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

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Suprasellar arachnoid cyst with delayed puberty.

Raj Kumar¹, Namit Singhal

¹Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow 226 014, UP, India. rajkumar@sgpgi.ac.in

Indian Pediatrics

|December 7, 2007

Summary

A rare case of a suprasellar arachnoid cyst caused delayed puberty and hypogonadism in a 15-year-old female. Surgical intervention for the cyst resolved the obstructive hydrocephalus and hormonal imbalances.

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Area of Science:

Pediatric Endocrinology
Neuro-oncology
Pediatric Neurosurgery

Background:

Suprasellar arachnoid cysts are rare intracranial cysts that can cause significant neurological issues.
Obstructive hydrocephalus is a common complication, often requiring surgical intervention such as endoscopic third ventriculostomy (ETV).
Delayed puberty and hypogonadism are potential endocrine consequences of mass effect in the sellar and suprasellar regions.

Observation:

A 15-year-old female presented with primary amenorrhea and delayed development of secondary sexual characteristics.
Previous history of ETV for a suprasellar arachnoid cyst with obstructive hydrocephalus.
Recurrent hydrocephalus was noted on MRI, alongside hormonal evidence of hypogonadism and growth hormone deficiency.

Findings:

The suprasellar arachnoid cyst was surgically treated via cyst fenestration.
Post-operative resolution of obstructive hydrocephalus.
Improvement in hormonal profiles suggestive of resolving hypogonadism and growth hormone deficiency.

Implications:

This case highlights an unusual presentation of a suprasellar arachnoid cyst causing delayed puberty.
Early diagnosis and management of suprasellar cysts are crucial to prevent long-term endocrine and developmental sequelae.
Fenestration of suprasellar arachnoid cysts can be an effective treatment for obstructive hydrocephalus and associated hormonal dysfunction.