Endoscopic endonasal management of sellar and suprasellar xanthogranulomas: A single-center experience

Öz

Aim: Sellar xanthogranuloma (XG) is a rare, tumor-like inflammatory lesion that often mimics Rathke’s cleft cysts or craniopharyngiomas radiologically and clinically. The endoscopic endonasal approach (EEA) has become the preferred surgical corridor for these midline cystic lesions; however, evidence on optimal extent of resection and postoperative outcomes remains limited. We analyzed the clinical, radiologic, and surgical features of pathologically confirmed sellar/suprasellar XGs treated via EEA at a tertiary skull-base center. Material and Methods: We retrospectively reviewed a prospectively maintained database of 6,597 EEAs performed between 1997 and 2025 and identified eight histologically confirmed XG cases. Demographics, presenting symptoms, imaging characteristics, surgical approach, extent of resection, and postoperative outcomes were analyzed. Results: The cohort comprised five females and three males (median age, 26.5 years; range, 13–67). Lesions were suprasellar in five patients (62.5%) and sellar in three (37.5%). Gross-total resection was achieved in seven patients (87.5%), and subtotal resection in one (12.5%). Postoperative complications included one cerebrospinal fluid (CSF) leak after an extended suprasellar approach (12.5%) and one case of transient diabetes insipidus; no other complications were observed. No recurrences were detected during follow-up. Conclusion: Sellar xanthogranulomas are benign inflammatory-degenerative lesions that closely resemble Rathke’s cleft cysts and craniopharyngiomas, rendering preoperative diagnosis challenging. EEA enables effective decompression with low morbidity when reconstruction is tailored to CSF-leak flow and capsule management is individualized. Long-term radiologic surveillance is preferable to aggressive reoperation.

Anahtar Kelimeler

• Endoscopic endonasal approach
• sella
• pituitary
• xanthogranuloma

Sellar ve suprasellar ksantogranülomaların endoskopik endonazal yönetimi: Tek merkez deneyimi

Öz

Amaç: Sellar ksantogranüloma (XG), radyolojik ve klinik olarak sıklıkla Rathke yarığı kistleri veya kraniofaringiomlarla karışan, nadir görülen, tümör benzeri inflamatuvar bir lezyondur. Endoskopik endonazal yaklaşım (EEA), bu orta hat kistik lezyonları için tercih edilen cerrahi yol haline gelmiştir; ancak optimal rezeksiyon düzeyi ve ameliyat sonrası sonuçlara ilişkin veriler sınırlıdır. Bu çalışmada, üçüncü basamak bir kafa tabanı merkezinde endoskopik endonazal yaklaşımla tedavi edilen patolojik olarak doğrulanmış sellar ve suprasellar ksantogranülomaların klinik, radyolojik ve cerrahi özellikleri analiz edilmiştir. Gereç ve Yöntemler: 1997–2025 yılları arasında gerçekleştirilen 6.597 endoskopik endonazal cerrahi içeren prospektif olarak tutulan bir veri tabanının retrospektif incelemesi sonucunda, histolojik olarak doğrulanmış sekiz ksantogranüloma olgusu belirlenmiştir. Demografik veriler, başvuru semptomları, görüntüleme bulguları, cerrahi yaklaşım, rezeksiyon düzeyi ve ameliyat sonrası sonuçlar analiz edilmiştir. Bulgular: Kohortta beş kadın ve üç erkek hasta yer almakta olup, ortanca yaş 26,5 (dağılım 13–67) idi. Lezyonlar beş hastada (%62,5) suprasellar, üç hastada (%37,5) sellar yerleşimliydi. Yedi hastada (%87,5) total rezeksiyon, bir hastada (%12,5) subtotal rezeksiyon gerçekleştirildi. Bir hastada (%12,5) genişletilmiş suprasellar yaklaşımdan sonra ameliyat sonrası beyin omurilik sıvısı (BOS) kaçağı, bir diğer hastada ise geçici diabetes insipidus gelişti; başka komplikasyon gözlenmedi. Takip süresince nüks saptanmadı. Sonuç: Sellar ksantogranülomalar, Rathke yarığı kistleri ve kraniofaringiomlarla benzer özellikler gösteren, benign inflamatuvar-dejeneratif lezyonlardır ve bu nedenle preoperatif tanı sıklıkla güçtür. Endoskopik endonazal cerrahi, BOS kaçağı derecesine göre uyarlanmış rekonstrüksiyon ve bireyselleştirilmiş kapsül yönetimi ile düşük morbiditeyle etkili bir dekompresyon sağlar. Uzun dönem radyolojik izlem, agresif yeniden cerrahiye tercih edilmelidir.

Anahtar Kelimeler

• Endoskopik endonazal yaklaşım
• sella
• hipofiz
• ksantogranüloma

Kaynakça

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