Intrasellar cysticercosis cyst treated with a transciliary supraorbital keyhole approach – A case report

Abstract

Background: Neurocysticercosis is the most common parasitic disease affecting the central nervous system. Isolated sellar cysticercosis cysts are rare and can mimic other sellar lesion as cystic pituitary adenoma, arachnoid cyst, Rathke cleft cyst, or craniopharyngioma. The surgical resection is mandatory because the cysticidal drugs are ineffective, however, new microsurgical approaches are emerging to reduce complications and need to test in this condition. We present a patient with a sellar cysticercosis cyst treated by transciliar supraorbital keyhole approach. Case Description: A 45-year-old female with presented with chronic severe headaches, progressive deterioration of 6 months in visual acuity and bitemporal hemianopia. The pituitary hormonal levels were normal. Magnetic resonance findings showed a sellar and suprasellar cyst and underwent a microsurgical supraorbital transciliar keyhole approach for lesion resection. Pathologically, the lesion demonstrated a parasitic wall characterized by wavy, dense cuticle, and focal globular structure, surrounding inflammatory reaction with plasma cells. Postoperatively, the patient recovery fully neurologically. Conclusion: Intrasellar cysticercosis cyst causes significant neurological deficits due to its proximity to the chiasm, optic nerves, pituitary stalk, and the pituitary gland. Surgical section is an effective treatment. The supraorbital keyhole craniotomy offers satisfactory exposure, possibility of total resection with dissection of the supra and parasellar structures, short operative time, less blood loss, short hospital stay, and good overall surgical outcome.

Endoscopic endonasal approach for isolated subarachnoid neurocysticercosis in basal cisterns and its complications: illustrative case

“…These lesions can mimic arachnoid cysts or tumors usual to the location, often more common than the parasitic disease itself. 4 , 7 , 8 Imaging findings of NCC are T1-weighted MRI hypointense and T2-weighted MRI hyperintense cyst and a minimal contrast enhancement of the walls and nodule (the scolex). Other sellar lesions, such as craniopharyngiomas, pituitary adenomas and arachnoid cysts, reveal different aspects on imaging: the first two present with vivid contrast enhancement and the last one presents without enhancement.…”

“… 9 , 10 Our patient had a feature from the first group: microscopy finding of a multilobate cyst with fibrous walls and inflammatory nature and an abundance of vesicles in a grape-like distribution, without a visible scolex. 8 …”

“…On the other hand, sellar, suprasellar, or retrochiasmatic region presentation, as in our patient's case, is exceedingly rare and has seldom been published. 4,[7][8][9][10] Most patients with intrasellar NCC present with a mass effect on adjacent cerebral areas. Therefore, ophthalmic and endocrine symptoms are the most common alterations.…”

“…Our patient reported only unspecific complaints such as worsening headaches and occasional dizziness. 4,[7][8][9]11,12 Imaging can aid the diagnosis. 1 However, on top of a challenging clinical diagnosis, neuroimaging can present nonspecific findings for NCC, especially in its subarachnoid sellar form.…”

“…Hence, a surgical procedure is required in most cases. 8 Herein, we discuss the case of a patient who presented with minimal symptoms of SUBNCC diagnosed using the expanded endoscopic endonasal approach and showed postoperative complications.…”