Results of surgical treatment of the Rathke cleft cysts with endoscopic endonasal cyts evacualtion – clinical series from pituitary referral center.

J. Kunicki*a (Dr), W. Bonickia (Prof), N. Rzewuskaa (Ms)

a Department of Neurosurgery, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Warsaw, POLAND

* jkunickii@gmail.com

Rathke's cleft cysts ( RCCs) are benign sellar and suprasellar lesions arising from epithelial remnants of Rathke's pouch.The symptomatic cases are treated surgically.
The aim: The aim of the study is to evaluate endoscopic endonasal approaches in the management of RCCs
Material and Methods: The study is a retrospective clinical case series analysis. We retrospectively analyzed a series of 71 patients complaining of a RCC, operated with endoscopic transsphenoidal approach at the Department of Neurosurgery M. Sklodowska-Curie National Research Oncological Institute during the period 2010-2021. In all cases the transsphenoidal endoscopic approach was performed. In 7 cases the extended approach was utilized.

Results: Simple cyst evacuation was possible in all cases, in 10 patients ( 15%) the tumor capsule was resected. In rest of the patients the evacuation of cyst was followed by capsule fenestration and biopsy and maneuvers to prevent it recollection. In 7 cases (10,1%) the extended transtuberculum sellae approach was used to resect suprasellar RCC.
In 52 (72%) patients RCC symptoms resolved. The visual performance improved in 12 out of 16 cases with visual degradation.The most frequent complication was transient diabetes insipidus in 12 cases (16,7%) , permanent DI was observed in 3 cases (4.1%).There was 1 case of cerebrospinal fluid leak. During the median observation time of 55 months recurrence/regrowth occurred in in 13 patients (18.4%) , only 4 cases needed reoperation for symptomatic recollection.

Conclusions The endoscopic endonasal transsphenoidal approach for the removal of a symptomatic RCC is safe and effective method of treatment. The modification of the approach to the so called "extended" approach, allows surgical treatment of isolated suprasellar RCCs eliminating the need for transcranial approach.

The author has declared no conflict of interest.