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Surgical outcomes and quality of life in Rathke’s cleft cysts undergoing endoscopic transsphenoidal resection: a multicentre study and systematic review of the literature

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Abstract

Objective

To establish the effect of endoscopic endonasal surgery (EES) on quality-of-life (QoL) in symptomatic Rathke cleft cyst (RCC).

Methods

Analysis of 38 patients with RCC treated by EES, with regular overall (ASBQ-35) and sinonasal-specific (SNOT-22) QoL assessment during the first postoperative year. A systematic literature review of large case series was performed with pooled analysis.

Results

In our series, mean age was 53.6 years with a female predominance (73.7%). Larger cysts were seen in males (p < 0.01), those with hypogonadism (p = 0.04), and visual dysfunction (p = 0.04). Complete normalisation of vision was seen in 83.3%. Persistence of visual dysfunction postoperatively was associated with diabetes (p = 0.005), hypertension (p = 0.02), suprasellar only location (p = 0.001), and monocular field cut (p = 0.02). Surgery did not significantly effect hormonal function. Sinonasal QoL transiently worsened after surgery, resolving within 3 weeks. A parallel transient worsening of overall QoL normalised by 6 weeks, and remained at preoperative baseline thereafter. These results were comparable to the literature, where 76.4% demonstrated improvement of vision and 13.1% had recurrence after treatment. There was no significant difference in outcomes between EES and microscopic approaches.

Conclusions

We report longitudinal QoL outcomes in RCC for the first time. Vision commonly improves with surgery, but endocrinopathy is likely to persist. Microvascular risk-factors may compromise visual improvement. Surgery causes a transient worsening of sinonasal symptoms that resolves within 3–6 weeks, but patients may not experience significant improvement in QoL within the first postoperative year.

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Data availability

Available on reasonable request, in writing, to the corresponding author.

Code availability

N/A.

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Acknowledgements

The first author is undertaking a higher degree funded by an Australian Government Research Training Program (RTP) Scholarship.

Funding

Nil funding.

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Authors and Affiliations

  1. Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia

    Mendel Castle-Kirszbaum, Jeremy Kam, Kylie Fryer & Tony Goldschlager

  2. Department of Neurosurgery, St Vincent’s Health, Melbourne, Australia

    Yi Yuen Wang

  3. Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia

    James King

  4. Department of Surgery, Monash University, Melbourne, Australia

    Tony Goldschlager

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  1. Mendel Castle-Kirszbaum
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Contributions

MCK (Analysis of the data, writing the draft, revision), JKa (data collection, analysis of the data, revision), YYW (data collection, analysis of the data, revision), JKi (data collection, analysis of the data, revision), TG (data collection, analysis of the data, revision, study supervision).

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Correspondence to Mendel Castle-Kirszbaum.

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Castle-Kirszbaum, M., Kam, J., Wang, Y.Y. et al. Surgical outcomes and quality of life in Rathke’s cleft cysts undergoing endoscopic transsphenoidal resection: a multicentre study and systematic review of the literature. Pituitary 25, 285–295 (2022). https://doi.org/10.1007/s11102-021-01197-6

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