Endoscopic Endonasal Surgery for the Treatment of Rathke’s Cleft Cysts

Introduction: Rathke’s cleft cysts (RCCs) are benign epithelial lesions of the sellar region. There is limited evidence to guide patient selection for operative treatment, and little literature describing contributing factors for cyst recurrence and outcome status.

Methods: We performed a retrospective review of all patients who underwent endoscopic endonasal approaches (EEA) for RCC from 2012 to 2018 at our tertiary care center. Data on tumor characteristics, clinical presentations, postoperative course and long-term follow-up was collected and analyzed.

Results: A total of 34 patients were identified and included. Mean patient age at presentation was 46 years (range: 22–81). Twenty-seven (79%) patients were female. Preoperative symptoms included headaches (77%), vision loss (53%), and hypopituitarism (56%). The mean cyst diameter was 16.9 mm (range: 9–30 mm). Extended approaches were utilized in 16% of cases. On postoperative MRI, there was no cyst visible in 47% of patients. Postoperative complications included: CSF rhinorrhea (9%), meningitis (3%), sinusitis (3%), and carotid artery injury without neurological sequelae in a patient with an inflammatory and refractory RCC. The mean follow-up time was 16.5 months. Headache improvement was noted in 24 of 26 patients (92%), and vision improved in 17 of 18 patients (94%) with preoperative vision loss. Of 19 patients with preoperative hypopituitarism, 7 (37%) showed improvement in at least one hormonal axis. There were two new cases of panhypopituitarism (6%). There were three recurrences (9%) within the follow-up period (average time to recurrence: 24 months).

Conclusion: Our series comprises one of the largest purely endoscopic datasets analyzing the treatment of Rathke’s cleft cyst. Patients who underwent an EEA benefited from rapid and sustained improvements in vision and headache, with some experiencing improved endocrine function.