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Clinical features and surgical outcomes of Rathke cleft cysts with suprasellar components: a single-center experience of 157 cases

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Abstract

Background

Both intrasuprasellar and suprasellar Rathke cleft cysts (RCCs) have suprasellar components, and we aimed to explore their clinical features and surgical outcomes.

Method

Patients with surgically treated intrasuprasellar or suprasellar RCCs were retrospectively analyzed. All patients with intrasuprasellar RCCs were treated with the standard endoscopic endonasal approach (EEA, group I); the patients with suprasellar RCCs received the extended EEA (group II) or supraorbital keyhole approach (SKA, group III) according to the relevant indications. A surgical strategy of maximal safe resection aiming to protect neuroendocrine function was adopted. In addition, patients (distinguished from the above 3 groups) who had aggressive resection of suprasellar RCC were also enrolled for comparison of different surgical strategies.

Results

A total of 157 patients were eligible, including 121 patients with intrasuprasellar RCCs in group I, 19 patients with suprasellar RCCs in group II, and 17 patients with suprasellar RCCs in group III. Preoperatively, the patients with suprasellar RCC (groups II and III) more commonly presented with visual dysfunction, diabetes insipidus (DI), and hyperprolactinemia than the patients with intrasuprasellar RCCs (all p<0.05). A higher incidence of hypopituitarism and a larger diameter were observed for intrasuprasellar RCCs (both p<0.05). Postoperatively, group II had a higher rate of new-onset DI, hyponatremia, and recurrence than group I (all p<0.025) and similar outcomes to group III. For suprasellar RCCs, comparison of the maximal safe resection vs. aggressive resection (supplementary patients: 14 with extended EEA, 12 with SKA) showed similar improvement and recurrence, with higher rates of DI and hyponatremia with the latter strategy (all p<0.05).

Conclusions

Suprasellar RCC is associated with more complicated preoperative presentations, intricate postoperative complications, and frequent recurrence compared with intrasuprasellar RCC. Under rational indications, both extended EEA and SKA achieve satisfactory outcomes. The strategy of maximal safe resection is recommended for greatest functional preservation.

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Data availability

The data used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

Rathke cleft cyst:

RCC

EEA:

Endoscopic endonasal approach

SKA:

Supraorbital keyhole approach

CSF:

Cerebrospinal fluid

GTR:

Gross total resection

DI:

Diabetes insipidus

ADH:

Antidiuretic hormone

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Acknowledgments

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Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Ao Qian, Jing Zhou, Gang Huo & Xiaoshu Wang

  2. Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Ruichun Li

  3. Department of Neurosurgery ward II, BaZhong Central Hospital, Bazhong, China

    Jiaojiao Yu

Authors
  1. Ao Qian
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  2. Ruichun Li
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  4. Jiaojiao Yu
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  5. Gang Huo
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  6. Xiaoshu Wang
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Contributions

All authors contributed to the study conception and design. Xiaoshu Wang conceived and designed the study, and contributed to the surgery. Gang Huo contributed to the surgery and prepared the figures. Ao Qian interpreted the results and drafted the manuscript. Ruichun Li checked and revised the manuscript. Jing Zhou collected and analyzed the data, and wrote the section “Statistical analysis.” Jiaojiao Yu prepared the tables.

Corresponding author

Correspondence to Xiaoshu Wang.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the First Affiliated Hospital of Chongqing Medical University Ethical Committee (approval number: 2021-37) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all participants.

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The authors declare no competing interests.

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Qian, A., Li, R., Zhou, J. et al. Clinical features and surgical outcomes of Rathke cleft cysts with suprasellar components: a single-center experience of 157 cases. Acta Neurochir 165, 2267–2276 (2023). https://doi.org/10.1007/s00701-023-05617-3

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