Surgical Management of Rathke Cleft Cysts

Ratha, Vishwaraj; Patil, Subodh; Karmarkar, Vikram; Shah, Nishit; Deopujari, Chandrashekhar

doi:10.1016/j.wneu.2017.07.164

Cited by 26 publications

(24 citation statements)

References 26 publications

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“…It must be noted, that in the studies of Fan et al., all of their 49 patients were treated with STR, none received GTR. In all of the other studies, the rate of permanent new hypopituitarism was 0%. Madhok et al .…”

Section: Intradural Tumorsmentioning

confidence: 73%

“…Overall, postoperative CSF leaks were reported in 10 of 191 patients (5%). Madhok et al., Jahangiri et al., and Ratha et al . reported a 0% rate for CSF leaks in their patient groups.…”

Section: Intradural Tumorsmentioning

confidence: 86%

“…In 1 study with 9 suprasellar RCCs approached by extended EEA, headache improved only in 71% . In another study by Ratha et al., headache was the predominant symptom in 93%. Fifty‐two percent (52%) had purely intrasellar RCC and 48% had intrasellar RCC with suprasellar extension.…”

Section: Intradural Tumorsmentioning

confidence: 92%

“…and Xie et al . reported a 50% improvement rate for hypopituitarism, the other included studies reported a 22% to 33% or 0% improvement rate.…”

Section: Intradural Tumorsmentioning

confidence: 98%

“…used DuraGen for lining the defect and then an NSF. Ratha et al . used floor repair with only collagen sponge in small CSF leaks, and additional fat and fascia lata sometimes with lumbar drain in large CSF leaks.…”

Section: Intradural Tumorsmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

137

268

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Intradural Tumorsmentioning

confidence: 73%

“…Overall, postoperative CSF leaks were reported in 10 of 191 patients (5%). Madhok et al., Jahangiri et al., and Ratha et al . reported a 0% rate for CSF leaks in their patient groups.…”

Section: Intradural Tumorsmentioning

confidence: 86%

Section: Intradural Tumorsmentioning

confidence: 92%

“…and Xie et al . reported a 50% improvement rate for hypopituitarism, the other included studies reported a 22% to 33% or 0% improvement rate.…”

Section: Intradural Tumorsmentioning

confidence: 98%

Section: Intradural Tumorsmentioning

confidence: 99%

See 3 more Smart Citations

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

137

268

View full text Add to dashboard Cite

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Preventing Restenosis of Marsupialized Rathke Cleft Cysts Using a Nasoseptal Flap Lining

et al. 2019

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Objectives Rathke cleft cysts (RCCs) are rare, benign lesions formed from remnants of Rathke pouch during embryologic development. However, following marsupialization, maintaining tract patency remains a challenge. Several techniques for decreasing stenosis have been described, including free mucosal grafting, silastic spacing, and using steroid‐eluting stents. Nasoseptal flaps (NSFs) have a reliable vascular supply and are widely utilized in skull base reconstruction. We present a novel technique to maintain patency of the marsupialized RCC cavity by lining it with an NSF to promote long‐term drainage and re‐epithelialization of the RCC cavity. Methods Retrospective chart review of all patients who underwent surgery for symptomatic RCCs. These patients underwent endoscopic endonasal surgery between February 3, 2016, and June 12, 2018, with marsupialization followed by circumferential NSF lining. Primary outcomes include symptomatic control, surgical complications, and RCC cavity patency. Results Seven patients underwent RCC marsupialization with no intraoperative cerebrospinal fluid leak, followed by circumferential lining of the marsupialized cavity with an NSF. In each case, no cyst re‐accumulation or recurrent symptoms were noted, and the NSF lining provided long‐term patency of the tract in all cases to a mean of 6.7 ± 10.1 months of follow‐up, including one patient with sustained patency at 29 months follow‐up. Conclusion Utilization of the NSF to “stent open” the RCC cavity following marsupialization is a safe and effective means to prevent restenosis. Advantages include sustained patency of RCC cavity for complete drainage and a dependable vascular supply. Level of Evidence 4 Laryngoscope, 129:2258–2261, 2019

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