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Because of its deep anatomy and proximity to neurovascular and endocrine structures, diagnosis and surgery are difficult. Two adult symptomatic cases with progressive visual impairment were treated successfully using endoscopic endonasal surgery. A literature review of 47 prior surgical reports (49 total patients) assessed symptoms, imaging, operative strategies, and outcomes, highlighting high rates of symptom resolution or improvement. Early diagnosis and tailored endoscopic intervention with skull base reconstruction are emphasized.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/clinical-characteristics-and-surgical-management-of-symptomatic-trans-sellar-encephalocele-two-case-reports-and-a-review-of-the-literature/441200/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/clinical-characteristics-and-surgical-management-of-symptomatic-trans-sellar-encephalocele-two-case-reports-and-a-review-of-the-literature/441200.png","ImageObject",300,407,{"name":92,"@type":93},"River Wang","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is trans-sellar encephalocele and why is it challenging to manage surgically?","Question",{"text":112,"@type":113},"It is a rare basal encephalocele subtype where neural tissue herniates through a sellar floor defect into nearby aerodigestive spaces. Its deep location and proximity to critical neurovascular and endocrine structures make both diagnosis and operative management difficult.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were the two adult symptomatic cases treated and what were the results?",{"text":117,"@type":113},"Both adults with progressive visual impairment underwent endoscopic endonasal surgery. Postoperative findings confirmed reduction of the trans-sellar encephalocele and cessation of cerebrospinal fluid inflow, with improved visual symptoms without recurrence or complications.",{"name":119,"@type":110,"acceptedAnswer":120},"What symptoms and patient-level patterns were most common in the 49 reviewed cases?",{"text":121,"@type":113},"Across 49 patients, nasal obstruction, endocrine dysfunction, cerebrospinal fluid leakage, and visual impairment were common. Most patients were diagnosed at age six or younger, and surgery was primarily performed via transnasal approaches.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},441200,1790793107,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1099514067438,"https://ap-avatar.wpscdn.com/avatar/100002539ee87300030?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780474512215547542","NMC Case Report Journal 12, 531-540, 2025  \nClinical Characteristics and Surgical Management of Symptomatic Trans-sellar Encephalocele: Two Case Reports and a Review of  \nthe Literature  \nHoai Thi Phuong DINH,1,2 Kosaku AMANO,3 Shinichiro KOIZUMI,1 Yukihiro MATSUYAMA,2 Kazuhiko KUROZUMI,1 and Takakazu KAWAMATA3  \n1 Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan 2 Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan 3 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan  \nAbstract  \nTrans-sellar encephalocele is a rare subtype of basal encephalocele characterized by herniation of neural tissue through a defect in the sellar floor, extending into the sphenoid sinus or nasopharynx. Due to its deep anatomical location and proximity to critical neurovascular and endocrine structures, trans-sellar encephalocele presents significant diagnostic and surgical challenges. We report two adult cases of symptomatic trans-sellar encephalocele with progressive visual impairment, both successfully treated via endoscopic endonasal surgery. In addition, to contextualize these cases, we conducted a comprehensive literature review of 47 previously reported symptomatic trans-sellar encephalocele that was surgically treated in the neurosurgical field over the past quarter century, resulting in a total 49 patients (33 males, 16 females). Clinical characteristics, imaging findings, surgical approaches, and outcomes were analyzed. Of the 49 patients, the common symptoms included nasal obstruction (59.2%), endocrine dysfunction (46.9%), cerebrospinal fluid leakage (30.6%), and visual impairment (24.5%). The majority (69.4%) were diagnosed at age six or younger. Surgery was performed primarily via transnasal approaches (49.4%). Outcomes were available in 44 cases; 81.8% experienced symptom resolution or improvement. In our two cases, postoperative imaging confirmed the reduction of the trans-sellar encephalocele and cessation of cerebrospinal fluid inflow. Visual symptoms improved without recurrence or complications. Early diagnosis and tailored surgical intervention are essential for optimizing outcomes in trans-sellar encephalocele. The endoscopic endonasal approach enables safe and effective reduction of the trans-sellar encephalocele while preserving critical structures. Modifying of cerebrospinal fluid dynamics appears to play a key role in halting symptom progression. Long-term follow-up and further studies are warranted to establish standardized management strategies.  \nKeywords: trans-sellar encephalocele, symptomatic, visual impairment, transnasal approach, skull base reconstruction  \nIntroduction  \nTrans-sellar encephalocele (TSE) is a rare subtype of basal encephalocele, characterized by congenital bone and dural defects in the skull base at the level of the sella turcica, often extending into the nasopharyngeal region. Encephaloceles are a form of cranial bifidum and result from  \nneural tube closure defects during embryogenesis, typically around gestational weeks 3 to 4. Basal encephaloceles are generally classified into six distinct anatomical subtypes: spheno-ethmoidal, trans-sphenoidal, trans-sphenoidal trans-sellar, spheno-orbital, trans-ethmoidal, and sphenomaxillary.1-3) In addition to symptoms caused by mass effect, TSE may present with a variety of manifestations re-  \nReceived July 23, 2025; Accepted August 26, 2025 Copyright Ⓒ 2025 The Japan Neurosurgical Society  \nThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.  \n531  \n532 HT. Dinh et al.  \nlated to the involvement of structures in the parasellar region. These lesions present considerable neurosurgical challenges due to their proximity to critical anatomical structures, including the optic chiasm, hypothalamicpituitary axis, circle of Willis, and cavernous sinuses.4) Preservation of the contents within","cbCaieo3CneFXLkM","https://ap.wps.com/l/cbCaieo3CneFXLkM","pdf",1566258,"English","# Introduction\n# Materials and Methods\n# Case","[{\"question\":\"What is trans-sellar encephalocele and why is it challenging to manage surgically?\",\"answer\":\"It is a rare basal encephalocele subtype where neural tissue herniates through a sellar floor defect into nearby aerodigestive spaces. Its deep location and proximity to critical neurovascular and endocrine structures make both diagnosis and operative management difficult.\"},{\"question\":\"How were the two adult symptomatic cases treated and what were the results?\",\"answer\":\"Both adults with progressive visual impairment underwent endoscopic endonasal surgery. Postoperative findings confirmed reduction of the trans-sellar encephalocele and cessation of cerebrospinal fluid inflow, with improved visual symptoms without recurrence or complications.\"},{\"question\":\"What symptoms and patient-level patterns were most common in the 49 reviewed cases?\",\"answer\":\"Across 49 patients, nasal obstruction, endocrine dysfunction, cerebrospinal fluid leakage, and visual impairment were common. Most patients were diagnosed at age six or younger, and surgery was primarily performed via transnasal approaches.\"}]","Clinical Characteristics and Surgical Management of Symptomatic Trans-sellar Encephalocele - Two Case Reports and a Review of the Literature | PDF",1790695094,25]