Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy
Background and Importance: Arachnoid cysts are developmental cystic lesions which may be found as an incidental finding on neuroimaging or present with symptoms of headache, seizure and neurologic deficit. Presentation with seizure is more common with larger sizes and temporal location. Presentatio...
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| Format: | Article |
| Language: | English |
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Guilan University of Medical Sciences
2019-04-01
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| Series: | Iranian Journal of Neurosurgery |
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| Online Access: | http://irjns.org/article-1-168-en.html |
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| author | Arash Saffarian Nima Derakhshan Mousa Taghipour Mohammad Faramarzi Ali Akbar Asadipooya Amirreza Dehghanian Keyvan Eghbal |
| author_facet | Arash Saffarian Nima Derakhshan Mousa Taghipour Mohammad Faramarzi Ali Akbar Asadipooya Amirreza Dehghanian Keyvan Eghbal |
| author_sort | Arash Saffarian |
| collection | DOAJ |
| description | Background and Importance: Arachnoid cysts are developmental cystic lesions which may be found as an incidental finding on neuroimaging or present with symptoms of headache, seizure and neurologic deficit. Presentation with seizure is more common with larger sizes and temporal
location. Presentation with Temporal Lobe Epilepsy (TLE) is rare, and fenestration of cysts has variable results for seizure control. We reported controlling TLE symptoms following endoscopic transsphenoidal fenestration of an arachnoid cyst. The anteromedial location in middle fossa, extension toward sphenoid sinus and normal appearance of mesial temporal structures on MRI encouraged us to consider this surgical approach.
Case Presentation: A 26-year-old patient with a 13-year history of TLE with uncontrolled symptoms despite taking a combination of AEDs (LTG, CBZ, LEV, CLB) was referred to our clinic. Neuroimaging revealed an arachnoid cyst in anteromedial part of temporal fossa which extended to sphenoid sinus, but showed no abnormality in mesial temporal structures. Endoscopic endonasal transsphenoidal fenestration of the arachnoid cyst was performed, and followed by reconstruction of the skull base. The procedure improved the seizure control during the 9-month follow-up and no sign of radiologic recurrence was observed.
Conclusion: Transsphenoidal endoscopic fenestration is a safe and feasible surgical approach for treatment of symptomatic arachnoid cysts in anteromedial part of middle fossa especially when they extend toward lateral wall of sphenoid sinus. This surgical corridor has the privilege of avoiding
cortical injury accompanied by transcranial approaches, which is deleterious in epileptic patients. |
| first_indexed | 2024-12-18T01:57:23Z |
| format | Article |
| id | doaj.art-f36c7ae2a89147dc9453455b55974663 |
| institution | Directory Open Access Journal |
| issn | 2423-6497 2423-6497 |
| language | English |
| last_indexed | 2024-12-18T01:57:23Z |
| publishDate | 2019-04-01 |
| publisher | Guilan University of Medical Sciences |
| record_format | Article |
| series | Iranian Journal of Neurosurgery |
| spelling | doaj.art-f36c7ae2a89147dc9453455b559746632022-12-21T21:24:52ZengGuilan University of Medical SciencesIranian Journal of Neurosurgery2423-64972423-64972019-04-01529398Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe EpilepsyArash Saffarian0Nima Derakhshan1Mousa Taghipour2Mohammad Faramarzi3Ali Akbar Asadipooya4Amirreza Dehghanian5Keyvan Eghbal6 Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran 1. Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran 2. Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Background and Importance: Arachnoid cysts are developmental cystic lesions which may be found as an incidental finding on neuroimaging or present with symptoms of headache, seizure and neurologic deficit. Presentation with seizure is more common with larger sizes and temporal location. Presentation with Temporal Lobe Epilepsy (TLE) is rare, and fenestration of cysts has variable results for seizure control. We reported controlling TLE symptoms following endoscopic transsphenoidal fenestration of an arachnoid cyst. The anteromedial location in middle fossa, extension toward sphenoid sinus and normal appearance of mesial temporal structures on MRI encouraged us to consider this surgical approach. Case Presentation: A 26-year-old patient with a 13-year history of TLE with uncontrolled symptoms despite taking a combination of AEDs (LTG, CBZ, LEV, CLB) was referred to our clinic. Neuroimaging revealed an arachnoid cyst in anteromedial part of temporal fossa which extended to sphenoid sinus, but showed no abnormality in mesial temporal structures. Endoscopic endonasal transsphenoidal fenestration of the arachnoid cyst was performed, and followed by reconstruction of the skull base. The procedure improved the seizure control during the 9-month follow-up and no sign of radiologic recurrence was observed. Conclusion: Transsphenoidal endoscopic fenestration is a safe and feasible surgical approach for treatment of symptomatic arachnoid cysts in anteromedial part of middle fossa especially when they extend toward lateral wall of sphenoid sinus. This surgical corridor has the privilege of avoiding cortical injury accompanied by transcranial approaches, which is deleterious in epileptic patients.http://irjns.org/article-1-168-en.htmltemporal lobe epilepsy (tle)neuroendoscopytranssphenoidalarachnoid cyst |
| spellingShingle | Arash Saffarian Nima Derakhshan Mousa Taghipour Mohammad Faramarzi Ali Akbar Asadipooya Amirreza Dehghanian Keyvan Eghbal Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy Iranian Journal of Neurosurgery temporal lobe epilepsy (tle) neuroendoscopy transsphenoidal arachnoid cyst |
| title | Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy |
| title_full | Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy |
| title_fullStr | Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy |
| title_full_unstemmed | Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy |
| title_short | Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy |
| title_sort | endoscopic transsphenoidal fenestration of a medial temporal arachnoid cyst with extension to sphenoid sinus in a patient with temporal lobe epilepsy |
| topic | temporal lobe epilepsy (tle) neuroendoscopy transsphenoidal arachnoid cyst |
| url | http://irjns.org/article-1-168-en.html |
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