Rathke’s cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis

Barkhoudarian, Garni; Palejwala, Sheri K.; Ansari, Shaheryar F.; Eisenberg, Amy; Huang, Xiangfeng; Griffiths, Chester F; Rettinger, Sarah; Lavin, Norman; Kelly, Daniel F.

doi:10.1007/s11102-019-00962-y

Cited by 35 publications

(33 citation statements)

References 27 publications

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“…Less frequent benign pathologies in the sellar and suprasellar region are Rathke's cleft cysts and craniopharyngiomas. The former are embryological remnants of the Rathke pouch and only require surgical removal in case of mass-effect or progressive growth (8,9). The latter are congenital tumors of the central nervous system, believed to arise from residual ectoblastic cells of the craniopharyngeal duct.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients

et al. 2021

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BackgroundThe endoscopic endonasal transsphenoidal approach (EETA) is an established technique for the resection of a large variety of benign sellar and suprasellar lesions, mostly pituitary adenomas. It has clear advantages over the microscopic approach, like a superior close-up view of the relevant anatomy and the tumor-gland interface, an enlarged working angle, as well as an increased panoramic vision inside the surgical area. We have been performing the EETA for over a decade, and this study will focus on perioperative and postoperative outcomes and complications and their association with the learning curve.Material and MethodsAll patients in our tertiary referral center (n = 369) undergoing an EETA for a lesion of the sellar and suprasellar region between January 1st 2008 and December 31st 2018 were included, and data were retrospectively retrieved from the electronic patient records.ResultsMedian follow-up after surgery was 55 months. Pituitary adenomas (n = 322) were the most frequent pathology. Headache (43.4%) and loss of vision (29.3%) were the most common presenting symptoms. Median procedure duration was significantly longer during the initial 5 years (106 versus 79 minutes; p <0.0001), but incidence of peri- and postoperative CSF leaks in the early years was not significantly higher. Knosp grade >2 was associated with perioperative CSF leak (p =0.002), and perioperative CSF leak was associated with postoperative CSF leak (p <0.001). Almost all cases of meningitis were preceded by a postoperative CSF leak. In 22.4% of patients, tumor recurrence required additional therapy. Perioperative (iatrogenic) mortality was 0.8%. The overall hospital stay decreased over time from an average of 7 to 5 days, and the case load increased yearly (p =0.015).ConclusionThe EETA is an excellent technique with complication rates comparable to or even lower than those in large microsurgical series in the literature. EETA has a significant learning curve affecting the procedure duration. Throughout the first 10 years following the transition from the microscopic approach to the EETA in our cohort, the caseload increased and hospital stay was reduced, while no increase in peri- and postoperative complications was observed.

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Section: Introductionmentioning

confidence: 99%

Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients

et al. 2021

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“…A further accumulation of cases is needed to clarify the relationship between endocrinopathy and signal intensity. Some reports indicate that the majority of RCCs are stable in size and that some RCCs may experience change; however, a retrospective RCC study reported that the predicted mean cystic growth rate was not significantly different from zero (24)(25)(26).…”

Section: Discussionmentioning

confidence: 98%

The clinical course of Rathke’s cleft cysts in pediatric patients: impact on growth and pubertal development

Higuchi

Hasegawa

Kubo

et al. 2022

Clin Pediatr Endocrinol

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Rathke's cleft cysts (RCCs) are non-neoplastic epithelial lesions in the sellar or suprasellar regions. RCCs are usually asymptomatic; however, some patients experience headaches, visual disturbances, and endocrine disorders. The best treatment for associated endocrinopathy remains elusive. We aimed to investigate the clinical course, magnetic resonance imaging findings, and response to therapy in 10 pediatric patients with RCCs and endocrinopathy. Growth impairment and precocious puberty were observed to be prevalent.One patient with suprasellar extension of RCC underwent surgery, while the others were treated medically. Of the nine patients, seven patients showed stable cyst size, while two patients displayed reduction in cyst size. Hormone replacement and gonadotropin suppression therapy were found to be effective. Imaging and endocrine follow-ups are warranted because of the potential for changes in the cyst size and hormonal changes.

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“…The dose was adjusted to relieve his thirst, polydipsia, and dilute polyuria, and his symptoms resolved after taking 120 μg/day (twice daily) of desmopressin. Regarding the treatment plan for his RCC, surgical treatment was considered a potentially effective option to prevent future development of additional pituitary defects, but it may not necessarily resolve CDI ( 1 , 2 , 10 ). After the patient was informed of the treatment options, he chose conservative treatment.…”

Section: Case Reportmentioning

confidence: 99%

Central Diabetes Insipidus after Syndrome of Inappropriate Antidiuretic Hormone Secretion with Severe Hyponatremia in a Patient with Rathke's Cleft Cyst

et al. 2022

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A 49-year-old man developed severe hyponatremia associated with transient headache and was diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Fluid restriction and sodium supplementation corrected the hyponatremia. However, several days later, the patient exhibited hypernatremia with thirst and polyuria. A detailed examination indicated central diabetes insipidus (CDI) with an intrasellar cystic lesion indicative of Rathke's cleft cyst (RCC). A case of RCC exhibiting headache, hyponatremia, and subsequent hypernatremia has been reported. Our case shows that CDI may appear after SIADH in patients with RCC, especially in those with serum sodium levels that unexpectedly increase rapidly beyond the reference range.

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Rathke’s cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis

Cited by 35 publications

References 27 publications

Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients

Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients

The clinical course of Rathke’s cleft cysts in pediatric patients: impact on growth and pubertal development

Central Diabetes Insipidus after Syndrome of Inappropriate Antidiuretic Hormone Secretion with Severe Hyponatremia in a Patient with Rathke's Cleft Cyst

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