Endoscopic endonasal resection of symptomatic Rathke cleft cysts: clinical outcomes and prognosis

Jiang, Zhongzhong; Yu, Meihong; Jiang, Yugang; Peng, Yong

doi:10.1007/s10143-018-01058-0

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…Most studies advocate for fenestration and aspiration of cyst contents +/− partial excision of the cyst wall [ 19 , 22 , 23 ]. Although a theoretical risk of recurrence exists, Fan et al found that gross total resection did not reduce the recurrence rate but increased the risk of postoperative complications [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Rathke’s Cleft Cysts: The Case for Simple Fenestration

et al. 2022

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Background: Rathke’s cleft cysts (RCC) arise from the pars intermedia because of incomplete regression of the embryologic Rathke pouch. A subset of RCC becomes symptomatic causing headaches, visual and endocrinological disturbances such that surgical intervention is indicated. Several points in surgical management remain controversial including operative strategy (simple fenestration (SF) vs complete cyst wall resection (CWR)) as well as reconstructive techniques. Methods: A retrospective analysis was conducted of pathologically confirmed RCC operated on by endoscopic endonasal approach from 2006 to 2019. Pre-operative symptoms, imaging characteristics, operative strategy, symptom response, complications and recurrences were recorded. Results: Thirty-nine patients were identified. Thirty-three underwent SF and six underwent CWR. Worsening pituitary function was significantly increased with CWR (50%) compared to SF (3%) (p = 0.008). All patients underwent “closed” reconstruction with a post-operative CSF leak rate of 5% (3% SF vs 16% CWR, p = 0.287). Six (15%) recurrences necessitating surgery were reported. Recurrence rates stratified by surgical technique (18% SF vs 0% CWR, p = 0.564) were not found to be significantly different. Conclusions: The current series illustrates variability in the surgical management of RCCs. SF with closed reconstruction is a reasonable operative strategy for most symptomatic RCCs cases while CWR can be reserved for selected cases.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Rathke’s Cleft Cysts: The Case for Simple Fenestration

et al. 2022

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“…[20] The TSA using a microscope and, more recently, an endoscope has been used for surgical treatment of RCCs. [8,[10][11][12]17,23,24] Although very rare, craniotomy might be required for a giant or purely suprasellar RCC. [25] Table 3 Surgical outcomes of the 38 patients with surgically-treated Rathke cleft cysts.…”

Section: Discussionmentioning

confidence: 99%

The surgical outcomes following transsphenoidal surgery for Rathke cleft cysts: Comparison of the surgical approaches at a single institution

2022

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The aim of the present study is to retrospectively analyze the surgical outcomes and complications of microscopic and endoscopic transsphenoidal surgery in the management of Rathke cleft cysts (RCCs) at a single institution. A total of 38 patients were enrolled in this study. All patients were diagnosed with RCCs, which were confirmed histopathologically. Endocrine function, radiological, and clinical outcomes were evaluated following surgery. This cohort study consisted of 16 male and 22 female patients. The median age was 48 years (range, 21–72). The median clinical follow-up duration was 57 months (range, 3–187). Twenty-five patients underwent microscopic transsphenoidal surgery and 13 patients underwent endoscopic surgery. The cysts were located within the intrasellar area in 18 (47.4%) patients, and extended to the suprasellar area in 20 (52.6%) patients. The radiological characteristics were similar in the microscope and endoscope groups, except mass volume (1.40 vs 0.65 mm 3 ; P = .003) and peripheral rim enhancement ( P = .036). After surgery, 30 (78.9%) of the 38 patients had no residual cysts. There was no significant difference in outcomes between both groups (76.0% vs 84.6%; P = .689). Four (10.5%) patients experienced cyst recurrence in only the microscope group. Twenty-four of the 25 patients who presented with headache showed improvement after surgery. Four patients with visual field defects recovered after surgery. Among the 8 patients with hormonal deficiencies, hormone levels normalized in 5 patients, did not change in 2 patients and worsened in 1 patient. New hormonal deficiencies occurred in 3 patients. Microscopic or endoscopic transsphenoidal surgery for RCCs is a safe and effective treatment option. Complete aspiration of the cyst contents with wide fenestration and wall biopsy, regardless of the surgical approach used, is usually a sufficient treatment for RCCs.

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“…Rathke’s cleft cysts (RCCs) are the most common incidentally discovered sellar lesions, followed by pituitary adenomas ( 1 , 2 ). They are believed to derive from remnants of Rathke’s pouch, a dorsal invagination of the stomodeal ectoderm, typically positioned between the adenohypophysis and the neurohypophysis ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts

et al. 2022

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PurposeWe aimed to assess factors influencing the occurrence of delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts (RCCs).MethodsWe retrospectively collected the clinical data of patients who underwent transsphenoidal surgery for RCCs from January 2014 to January 2022. Univariate and multivariate analyses were used to determine the factors influencing the occurrence of postoperative delayed hyponatremia.ResultsOf the 78 microscopic transsphenoidal surgery recipients with RCCs, 15 experienced postoperative delayed hyponatremia. There were 35 men and 43 women, and mean age was 43.75 ± 14.95 years. The clinical manifestations of RCCs were headache (62 cases, 79.5%), visual dysfunction (35 cases, 44.9%), endocrine dysfunction symptoms (12 cases, 15.4%). After transsphenoidal surgery, 93.5% (58/62) had improvements in headache, and 97.1% (34/35) had improved or resolved compressive visual symptoms. Delayed hyponatremia occurred on average on day 6.46 and lasted on average for 4.40 days. Logistic regression analysis showed that the independent influencing factor of delayed hyponatremia after transsphenoidal surgery in patients with RCCs was postoperative diaphragma sellae height.ConclusionPostoperative diaphragma sellae height was identified as an independent influencing factor for delayed hyponatremia after transsphenoidal surgery in patients with RCCs.

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Endoscopic endonasal resection of symptomatic Rathke cleft cysts: clinical outcomes and prognosis

Cited by 13 publications

References 29 publications

Endoscopic Treatment of Rathke’s Cleft Cysts: The Case for Simple Fenestration

Endoscopic Treatment of Rathke’s Cleft Cysts: The Case for Simple Fenestration

The surgical outcomes following transsphenoidal surgery for Rathke cleft cysts: Comparison of the surgical approaches at a single institution

Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts

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