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

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Abstract

The aim of this study is to investigate the clinical presentation and outcomes associated with endoscopic endonasal resection of Rathke cleft cysts (RCCs). The authors retrospectively studied a series of 13 patients who were diagnosed with RCCs after endoscopic endonasal resection at the Second Xiangya Hospital between June 2016 and December 2017. All 13 patients (8 women) underwent a purely endoscopic endonasal approach (EEA) for fenestration and aspiration of RCCs with excision of the cystic wall. The patient ages varied from 25 to 67 years (mean, 45.1 years), and the follow-up period ranged from 8 to 25 months (mean, 16.6 months). Headache was a presenting symptom in all 13 patients, with 11 (80%) out of the 13 having experienced postoperative improvement of their headaches. Six (46%) of the 13 patients were admitted with pituitary dysfunction, all of them had postoperative improvement. Four (31%) of the 13 patients had temporary postoperative pituitary dysfunction, although there was not any permanent pituitary dysfunction. Six patients had intraoperative complications with CSF leaks, and after the operation, three of them developed temporary diabetes insipidly, one of them had a postoperative infection, and another one had postoperative cerebrospinal fluid leaks, who was treated with absolute bed rest for 7 days. No patient experienced recurrent cysts. EEA is a safe and effective approach for the treatment of symptomatic RCCs. Notably, it is appreciated for protecting and restoring pituitary function; however, the postoperative recurrence rate still lacks a large sample related to the long time follow-up study. Complete aspiration of the cysts’ contents with partial excision of the cyst wall is usually sufficient for treatment.

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References

  1. Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH (2005) Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102:189–193. https://doi.org/10.3171/jns.2005.102.2.0189

    Article  PubMed  Google Scholar 

  2. Binning MJ, Gottfried ON, Osborn AG, Couldwell WT (2005) Rathke cleft cyst intracystic nodule: a characteristic magnetic resonance imaging finding. J Neurosurg 103:837–840. https://doi.org/10.3171/jns.2005.103.5.0837

    Article  PubMed  Google Scholar 

  3. Chaiban JT, Abdelmannan D, Cohen M, Selman WR, Arafah BM (2011) Rathke cleft cyst apoplexy: a newly characterized distinct clinical entity. J Neurosurg 114:318–324. https://doi.org/10.3171/2010.5.JNS091905

    Article  PubMed  Google Scholar 

  4. Chotai S, Liu Y, Pan J, Qi S (2015) Characteristics of Rathke’s cleft cyst based on cyst location with a primary focus on recurrence after resection. J Neurosurg 122:1380–1389. https://doi.org/10.3171/2014.12.JNS14596

    Article  PubMed  Google Scholar 

  5. Cohan P, Foulad A, Esposito F, Martin NA, Kelly DF (2004) Symptomatic Rathke’s cleft cysts: a report of 24 cases. J Endocrinol Investig 27:943–948. https://doi.org/10.1007/Bf03347537

    Article  CAS  Google Scholar 

  6. Culver SA, Grober Y, Ornan DA, Patrie JT, Oldfield EH, Jane JA Jr, Thorner MO (2015) A case for conservative management: characterizing the natural history of radiographically diagnosed Rathke cleft cysts. J Clin Endocrinol Metab 100:3943–3948. https://doi.org/10.1210/jc.2015-2604

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Frank G, Sciarretta V, Mazzatenta D, Farneti G, Modugno GC, Pasquini E (2005) Transsphenoidal endoscopic approach in the treatment of Rathke’s cleft cyst. Neurosurgery 56:124–129. https://doi.org/10.1227/01.neu.0000144824.80046.1f

    Article  PubMed  Google Scholar 

  8. Han SJ, Rolston JD, Jahangiri A, Aghi MK (2014) Rathke’s cleft cysts: review of natural history and surgical outcomes. J Neuro-Oncol 117:197–203. https://doi.org/10.1007/s11060-013-1272-6

    Article  Google Scholar 

  9. Ito M, Matsuda K, Kuge A, Sato S, Kayama T, Sonoda Y (2018) Treatment of Rathke’s cleft cyst:technical note for preservation of pituitary function. No Shinkei Geka 46:313–317. https://doi.org/10.11477/mf.1436203722

    Article  PubMed  Google Scholar 

  10. Jahangiri A, Molinaro AM, Tarapore PE, Blevins L Jr, Auguste KI, Gupta N, Kunwar S, Aghi MK (2011) Rathke cleft cysts in pediatric patients: presentation, surgical management, and postoperative outcomes. Neurosurg Focus 31:E3. https://doi.org/10.3171/2011.5.FOCUS1178

    Article  PubMed  Google Scholar 

  11. Kim E (2012) Symptomatic Rathke cleft cyst: clinical features and surgical outcomes. World Neurosurg 78:527–534. https://doi.org/10.1016/j.wneu.2011.12.091

    Article  PubMed  Google Scholar 

  12. Kim JE, Kim JH, Kim OL, Paek SH, Kim DG, Chi JG, Jung HW (2004) Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 100:33–40. https://doi.org/10.3171/jns.2004.100.1.0033

    Article  PubMed  Google Scholar 

  13. Laws ER, Kanter AS (2004) Rathke cleft cysts. J Neurosurg 101:571–572; discussion 572. https://doi.org/10.3171/jns.2004.101.4.0571

    Article  PubMed  Google Scholar 

  14. Madhok R, Prevedello DM, Gardner P, Carrau RL, Snyderman CH, Kassam AB (2010) Endoscopic endonasal resection of Rathke cleft cysts: clinical outcomes and surgical nuances. J Neurosurg 112:1333–1339. https://doi.org/10.3171/2009.10.JNS09348

    Article  PubMed  Google Scholar 

  15. Mendelson ZS, Husain Q, Elmoursi S, Svider PF, Eloy JA, Liu JK (2014) Rathke’s cleft cyst recurrence after transsphenoidal surgery: a meta-analysis of 1151 cases. J Clin Neurosci 21:378–385. https://doi.org/10.1016/j.jocn.2013.07.008

    Article  PubMed  Google Scholar 

  16. Mendelson ZS, Husain Q, Kanumuri VV, Eloy JA, Liu JK (2015) Endoscopic transsphenoidal surgery of Rathke's cleft cyst. J Clin Neurosci 22:149–154. https://doi.org/10.1016/j.jocn.2014.08.002

    Article  PubMed  Google Scholar 

  17. Nishioka H, Haraoka J, Izawa H, Ikeda Y (2006) Magnetic resonance imaging, clinical manifestations, and management of Rathke's cleft cyst. Clin Endocrinol 64:184–188. https://doi.org/10.1111/j.1365-2265.2006.02446.x

    Article  Google Scholar 

  18. Raper DM, Besser M (2009) Clinical features, management and recurrence of symptomatic Rathke's cleft cyst. J Clin Neurosci 16:385–389. https://doi.org/10.1016/j.jocn.2008.04.023

    Article  PubMed  Google Scholar 

  19. Ratha V, Patil S, Karmarkar VS, Shah NJ, Deopujari CE (2017) Surgical management of Rathke cleft cysts. World Neurosurg 107:276–284. https://doi.org/10.1016/j.wneu.2017.07.164

    Article  PubMed  Google Scholar 

  20. Sala E, Moore JM, Amorin A, Carosi G, Martinez H Jr, Harsh GR, Arosio M, Mantovani G, Katznelson L (2018) Natural history of Rathke’s cleft cysts: a retrospective analysis of a two centres experience. Clin Endocrinol 89:178–186. https://doi.org/10.1111/cen.13744

    Article  Google Scholar 

  21. Solari D, Cavallo LM, Somma T, Chiaramonte C, Esposito F, Del Basso De Caro M, Cappabianca P (2015) Endoscopic endonasal approach in the management of Rathke’s cleft cysts. PLoS One 10:e0139609. https://doi.org/10.1371/journal.pone.0139609

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Tate MC, Jahangiri A, Blevins L, Kunwar S, Aghi MK (2010) Infected Rathke cleft cysts: distinguishing factors and factors predicting recurrence. Neurosurgery 67:762–769; discussion 769. https://doi.org/10.1227/01.NEU.0000377017.53294.B5

    Article  PubMed  Google Scholar 

  23. Teramoto A, Hirakawa K, Sanno N, Osamura Y (1994) Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 193:161–164. https://doi.org/10.1148/radiology.193.1.8090885

    Article  CAS  PubMed  Google Scholar 

  24. Trifanescu R, Stavrinides V, Plaha P, Cudlip S, Byrne JV, Ansorge O, Wass JA, Karavitaki N (2011) Outcome in surgically treated Rathke’s cleft cysts: long-term monitoring needed. Eur J Endocrinol 165:33–37. https://doi.org/10.1530/EJE-11-0142

    Article  CAS  PubMed  Google Scholar 

  25. Trifanescu R, Ansorge O, Wass JA, Grossman AB, Karavitaki N (2012) Rathke’s cleft cysts. Clin Endocrinol 76:151–160. https://doi.org/10.1111/j.1365-2265.2011.04235.x

    Article  Google Scholar 

  26. Xie T, Hu F, Yu Y, Gu Y, Wang X, Zhang X (2011) Endoscopic endonasal resection of symptomatic Rathke cleft cysts. J Clin Neurosci 18:760–762. https://doi.org/10.1016/j.jocn.2010.10.014

    Article  PubMed  Google Scholar 

  27. Zada G (2011) Rathke cleft cysts: a review of clinical and surgical management. Neurosurg Focus 31:E1. https://doi.org/10.3171/2011.5.FOCUS1183

    Article  PubMed  Google Scholar 

  28. Zhong W, You C, Jiang S, Huang S, Chen H, Liu J, Zhou P, Liu Y, Cai B (2012) Symptomatic Rathke cleft cyst. J Clin Neurosci 19:501–508. https://doi.org/10.1016/j.jocn.2011.07.022

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China

    Zhongzhong Jiang, Mengqiang Yu, Yugang Jiang & Yong Peng

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  1. Zhongzhong Jiang
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  2. Mengqiang Yu
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  3. Yugang Jiang
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  4. Yong Peng
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Correspondence to Yong Peng.

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Jiang, Z., Yu, M., Jiang, Y. et al. Endoscopic endonasal resection of symptomatic Rathke cleft cysts: clinical outcomes and prognosis. Neurosurg Rev 42, 699–704 (2019). https://doi.org/10.1007/s10143-018-01058-0

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