Endocrinopathy, Vision, Headache, and Recurrence After Transsphenoidal Surgery for Rathke Cleft Cysts

Wait, Scott D.; Garrett, Mark P.; Little, Andrew S.; Killory, Brendan D.; White, William L.

doi:10.1227/01.neu.0000374768.16291.03

Cited by 49 publications

(55 citation statements)

References 26 publications

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“…24,27,28,34,50 This is mainly because some patients underwent GTR. In analyzing the complications with respect to the extent of resection, 47% of patients with GTR had complications, whereas only 8% and 9% of those who underwent TS/STR and TC/STR had complications associated with surgery; this difference was significant (p = 0.002).…”

Section: Outcome Analysismentioning

confidence: 99%

“…1,23,34 Furthermore, some authors even reported worsened vision after a transsphenoidal procedure due to the fat packing. 26,44,50 In recent years, the supraorbital keyhole craniotomy has been increasingly used to remove tumors of the sellar area. 4,10,18,52 Numerous publications have demonstrated the advantages of this keyhole approach over traditional craniotomy, including minimal exposure, shortened surgical duration, lower morbidity, and satisfactory cosmetic outcomes.…”

Section: Assessment Of Different Approachesmentioning

confidence: 99%

“…13,24,27,28,31,34,35,50 Even in the setting of RCCs with suprasellar location, multiple cases of extended transsphenoidal approaches for cyst removal have also been reported. 28,34,35 Other minimally invasive approaches, such as the supraorbital keyhole craniotomy, although being increasingly used to access sellar or parasellar tumors, have not yet been employed in removing RCCs.…”

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confidence: 99%

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Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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R athke cleft cysts (RCCs) are regarded as benign cystic lesions derived from a remnant of the Rathke pouch. They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.Traditionally, the 2 most common surgical approaches are the endonasal transsphenoidal route and the standard craniotomy. The endonasal approach is typically used for sellar lesions, whereas the craniotomy is indicated for suprasellar lesions. 2,11,38,40 Owing to its reduced invasiveness Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaObject. An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs.Methods. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra-and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15).Results. Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9).Conclusions. It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location....

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Section: Outcome Analysismentioning

confidence: 99%

Section: Assessment Of Different Approachesmentioning

confidence: 99%

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confidence: 99%

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Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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“…It has been reported that DI can develop after pituitary region surgery in up to 75% of cases 7,8,12,15,17 and after transsphenoidal surgery in 10%-44% of cases, 4,6,12 whereas hyponatremia can occur in up to 35% of cases after surgery of pituitary region lesions. 12,13 The management of hypernatremia and hyponatremia following pituitary or hypothalamic region surgery can often be complex and dependent on several variables.…”

Section: Discussionmentioning

confidence: 99%

Syndrome of alternating hypernatremia and hyponatremia after hypothalamic hamartoma surgery

Abla

Wait

Forbes

et al. 2011

FOC

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Object In this paper, the authors' goal was to describe the occurrence of alternating hypernatremia and hyponatremia in pediatric patients who underwent resection of hypothalamic hamartomas (HHs) for epilepsy. Hypernatremia in patients after pituitary or hypothalamic surgery can be caused by diabetes insipidus (DI), whereas hyponatremia can occur due to a syndrome of inappropriate antidiuretic hormone, cerebral salt wasting, or excessive administration of desmopressin (DDAVP). The triphasic response after surgery in the pituitary region can also explain variations in sodium parameters in such cases. Methods One hundred fifty-three patients with HH who underwent surgery were enrolled in a prospective study to monitor outcomes. Of these, 4 patients (2.6%) were noted to experience dramatic alterations in serum sodium values. The medical records of these patients were identified and evaluated. Results Patients' ages at surgery ranged from 1.2 to 6.0 years. All patients were girls. Two patients had Delalande Type IV lesions (of 16 total Type IV lesions surgically treated) and 2 had Type III lesions (of 39 total Type III lesions). All patients had a history of gelastic seizures refractory to medication. Seizure frequency ranged from 3 to 300 per day. After surgery, all patients experienced hypernatremia and hyponatremia. The largest fluctuation in serum sodium concentration during hospitalization in a single patient was 53 mEq/L (range 123–176 mEq/L). The mean absolute difference in maximum and minimum sodium values was 38.2 mEq/L. All patients exhibited an initial period of immediate DI (independent of treatment) after surgery followed by a period of hyponatremia (independent of treatment), with a minimum value occurring between postoperative Days 5 and 8. All patients then returned to a hypernatremic state of DI, and 3 patients still require DDAVP for DI management. A second occurrence of hyponatremia lasting several days without DDAVP administration occurred in 2 patients during their hospitalization between periods of hypernatremia. One patient stabilized in the normal range of sodium values prior to discharge from rehabilitation without the need for further intervention. At last follow-up, 3 patients are seizure-free. Conclusions Severe instability of sodium homeostasis with hypernatremia and hyponatremia is seen in up to 2.6% of children undergoing open resection of HH. This risk appears to be related to HH type, with a higher risk for Types III (2 [5.1%] of 39) and IV (2 [12.5%] of 16) lesions. Here, the authors describe alternating episodes of hypernatremia and hyponatremia in the postoperative period following HH surgery. Management of this entity requires careful serial assessment of volume status and urine concentration and will often require alternating salt replacement therapy with DDAVP administration.

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“…Although they are reported in as many as 3-22% of all autopsy studies, they are seldom symptomatic during life [5,6]. The most common clinical symptoms associated with RCCs are headache, impaired visual function, and endocrinological insufficiency [7,8]. RCCs can also cause delayed or precocious puberty, amenorrhea/galactorrhea, growth retardation, weight gain, and hypogonadism [9][10][11].…”

Section: Introductionmentioning

confidence: 99%