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

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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.

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