Entirely Suprasellar Rathke Cleft Cysts: Clinical Features and Surgical Efficacy of Endoscopic Endonasal Transtuberculum Sellae Approach

Hayashi, Yasuhiko; Kobayashi, Masaaki; Sasagawa, Yasuo; Oishi, Masahiro; Tachibana, Osamu; Nakada, Mitsutoshi

doi:10.1016/j.wneu.2019.03.011

Cited by 7 publications

(1 citation statement)

References 23 publications

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“…However, suprasellar RCCs are surgically difficult because of their close vicinity to the optic chiasm and infundibulum. A case series reported seven patients with suprasellar RCCs and surgery via endoscopic endonasal transtuberculum sellar approach relieved headache effectively and safely with the preservation of endocrinologic functions [ 23 ]. A retrospective review reported that compared to microsurgery, the extended endoscopic endonasal approach was associated with a significantly improved rate of complete RCC removal and improved visual outcomes, along with somewhat better headache outcomes [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Reverse Trans-Sellar Neuroendoscopic Management of a Large Rathke’s Cleft Cyst Causing Obstructive Hydrocephalus: A Case Report

Lee

Kwon

Choi

et al. 2022

Brain Tumor Res Treat

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Symptomatic Rathke’s cleft cysts (RCCs) can be treated by surgical procedures, usually through an endonasal transsphenoidal corridor using either a microscope or an endoscope. We report a large suprasellar extended RCC causing obstructive hydrocephalus, which was efficiently managed by a novel surgical route named “reverse” trans-sellar approach using transventricular neuroendoscopy. A 48-year-old woman complained of persistent headache and a tendency to fall that had begun 6 months previously. The images obtained from MRI scan showed intra- and supra-sellar cystic masses occupying the third ventricle with obstruction of the foramina of Monro and the aqueduct of Sylvius. The cystic wall showed a slight enhancement, and the cystic contents showed iso-signal intensity on T1-and T2-weighted images. Instead of trans-nasal trans-sellar surgery, we decided to operate using a conventional transventricular endoscope. A thin cystic capsule, which blocked the foramina of Monro and the aqueduct of Sylvius, was fenestrated and removed and a third ventriculostomy was performed. The defect in the infundibulum between sellar and suprasellar cysts was widened and used as a corridor to drain cystic contents (reverse trans-sellar route). The final pathological finding revealed an RCC with focal metaplasia. We efficiently managed a large RCC by transventricular neuroendoscopic surgery with cyst fenestration and third ventriculostomy and simultaneously drained the sellar contents using a novel surgical route. Reverse trans-sellar neuroendoscopic surgery is a relevant treatment option for selective patients with large suprasellar extensions of RCCs.

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Section: Discussionmentioning

confidence: 99%