Professor Rathke’s gift to neurosurgery: the cyst, its diagnosis, surgical management, and outcomes

Abstract

Purpose

Rathke cleft cysts (RCC) are a target for transsphenoidal surgery when symptomatic; however, the surgical techniques and outcomes continue to be of interest. Our goal is to highlight nuances in diagnosis, surgical philosophy and techniques, and outcomes.

Methods

We retrospectively reviewed a single surgeon experience in a contemporary series of RCC from April 2008 through December 2019. The clinical presentation, radiographic studies, intraoperative findings, histopathological diagnosis, postoperative complications, and outcome data were recorded and analyzed.

Results

A total of 131 endoscopic endonasal operations were performed on 116 patients (30 male, 86 female), with an average age of 39 years. We identified 102 patients without prior surgery, and 14 patients with prior surgery elsewhere. Postoperative complications included transient diabetes insipidus (DI) (n = 23, 20%), permanent DI (n = 5, 4%), SIADH (n = 6, 5%), epistaxis (n = 6, 5%), postoperative infection (n = 3, 2.5%), postoperative CSF leak (n = 1, < 1%), intrasellar hematoma (n = 1, < 1%), and stroke (n = 1, < 1%). Visual improvement was observed in 74% (n = 31/42) of patients presenting with visual loss, and headache improvement in 86% (n = 80/93). Overall, the recurrence rate in our cohort was 11%, with a lower recurrence rate seen in males (p = 0.02). The median follow-up duration was 15.2 months (interquartile range 1.7–52.3)

Conclusion

Our results reflect the philosophy of a conservative surgical approach, designed to preserve normal pituitary function, and avoid DI, while achieving the maximal feasible resection. Evacuation of the cyst contents and meticulous sampling of the cyst wall when possible for histopathological diagnosis are crucial. The postoperative relief of symptoms and signs is gratifying, as are the overall rates of recurrence and outcomes.

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Availability of data and materials

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors

Contributions

ASM and MPC collected the data, performed the statistical analysis, and drafting of this article. ERL was responsible for providing the data and critically revising the manuscript. All authors were responsible for critically revising the manuscript.

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Correspondence to Edward R. Laws.

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Approval was obtained from the ethics committee of Brigham and Women’s Hospital—Harvard Medical School (IRB# 2014P000427).

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Portions of this work were accepted as a poster presentation at the 31st annual meeting of North American Skull Base Society (2021 virtual symposium), February 13, 2021.

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Montaser, A.S., Catalino, M.P. & Laws, E.R. Professor Rathke’s gift to neurosurgery: the cyst, its diagnosis, surgical management, and outcomes. Pituitary (2021). https://doi.org/10.1007/s11102-021-01155-2

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Keywords

  • Rathke cleft cyst
  • Cystic pituitary lesions
  • Endoscopic transsphenoidal surgery