gms | German Medical Science

Objective: Although Rathke’s cleft cysts (RCCs) are rare and mostly asymptomatic lesions, symptoms when occurring can be serious, including visual impairment, headache and hormonal dysfunction. As there is little literature concerning surgical treatment of RCCs, the authors present their experience with endoscopic surgery of this disease.

Methods: In the present study, we included nineteen patients aged 25-86 years being treated surgically on RCCs between 02/2011 and 06/2018. 14 of these surgeries were performed via mononostril endoscopic approach and 5 surgeries via transcranial endoscopic-assisted approach. Operation was indicated in case of clinical symptoms or progress in size. In order to evaluate complications and outcome, surgical data, endoscopic videos, MRI imaging and follow-up data were retrospectively collected.

Results: Preoperatively, most frequent symptoms were visual impairment in 10 cases (53%), headache in 7 cases (37%) as well as hormonal disturbances in 8 cases (42%). Intraoperatively, in the transcranial cases the cysts were fenestrated and partially resected. In the endonasal cases, the cysts were drained in all cases and the diaphragm opened in 5/14 cases (36%). Postoperatively, 8/10 patients (80%) with visual impairment reported full recovery, 1/10 (10%) experienced visual improvement, and 1/10 (10%) did not report any change. Of the 7 patients with preoperative headache, 5 patients (71%) reported full recovery, 1 (14%) felt improvement and 1 (14%) did not report any change. Newly occurred neurological complications after surgery were 1 case (5%) of bitemporal hemianopsia and 1 case (5%) of large-area hypesthesia. Endocrinologically, 4/8 patients (50%) reported full recovery, 1/8 patients (13%) reported improvement, and 3/8 patients (38%) showed pituitary insufficiency with following long-time hormonal substitution. Pituitary insufficiency also newly occurred in 1/19 patients (5%). In all, 14/19 patients (74%) showed an intact pituitary function. In 2/19 cases (11%) a CSF fistula had to be reoperated.

Conclusion: Considering the high percentages of full recovery of most symptoms and the low intra- and postoperative complication rates, endoscopic surgical treatment of symptomatic Rathke’s cleft cysts is safe. Which approach should be favored should be the focus in further evaluations.