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Durable headache relief following endoscopic endonasal resection of sub-centimeter Rathke cleft cysts in medically refractory patients

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Abstract

Background

The most common presenting symptom in patients with both small and large Rathke cleft cysts (RCC) is headache (H/A). It is well established that patients with large RCC can have significant symptomatic improvement after cyst drainage. However, patients with small RCC (≤ 1 cm) are rarely operated on, even if they present with debilitating H/A. It is not well understood whether resection of these smaller RCCs can lead to durable H/A resolution.

Methods

A retrospective search of our institutional database for sub-centimeter RCCs presenting with intractable H/A and treated with an endoscopic endonasal approach was carried out. A detailed H/A questionnaire as well as patient chart review was conducted to assess the long-term outcome of these patients after surgical intervention.

Results

Ten consecutive patients with 11 endonasal surgeries met inclusion criteria. Eight responded to the questionnaire. The median cyst diameter was 6 mm (IQR 3–9). Median preoperative H/A duration was 12 months (range 2 months–15 years). H/As occurred on average for 20 days per month and all required analgesics for symptomatic control for more than 15 of these 20 days. Half of the patients also had to miss work because of H/A. Average preoperative H/A intensity was 8.7 (scale 0–10) compared with postoperative scores of 2.9 at one month, 1.6 at 3 months, and 0.9 at 1 year. There were no permanent endocrinological or other surgical complications. After a median follow-up of 2 years, one patient had radiographic and symptomatic recurrence which resolved after re-operation.

Conclusions

Endoscopic fenestration of sub-centimeter RCCs provides a safe and durable treatment for patients with intractable H/A.

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Abbreviations

RCC:

Rathke cleft cyst

H/A:

Headache

EEA:

Endoscopic endonasal approach

IRB:

Institutional Review Board

AAN-AHS:

American Academy of Neurology- American Headache Society

CSF:

Cerebrospinal fluid leak

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Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA

    Dimitrios Mathios, Shejoy Joshua, Ernest J. Bobeff, Adina A. Mistry, Alexandra C. Schwartz, Georgiana A. Dobri & Theodore H. Schwartz

  2. Department of Neurosurgery, Aster Medcity, Kochi, Kerala, India

    Shejoy Joshua

  3. Department of Neurosurgery, Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland

    Ernest J. Bobeff

  4. Department of Endocrinology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA

    Georgiana A. Dobri

  5. Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA

    Abtin Tabaee, Ashutosh Kacker & Vijay K. Anand

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  1. Dimitrios Mathios
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  2. Shejoy Joshua
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  10. Theodore H. Schwartz
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Correspondence to Theodore H. Schwartz.

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Mathios, D., Joshua, S., Bobeff, E.J. et al. Durable headache relief following endoscopic endonasal resection of sub-centimeter Rathke cleft cysts in medically refractory patients. Acta Neurochir 165, 2277–2282 (2023). https://doi.org/10.1007/s00701-023-05575-w

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  • DOI: https://doi.org/10.1007/s00701-023-05575-w

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