Endoscopic endonasal transsphenoidal approach for symptomatic Rathke cleft cyst: A case series

Abstract

The purpose of the present study was to evaluate the safety and effectiveness of the surgical method by reviewing the long-term outcomes of a series of symptomatic Rathke cleft cyst (RCC) cases. The surgical approach was the endoscopic transsphenoidal approach and the surgical strategy was intracapsular decompression, excision of cyst contents, partial excision of the cyst wall and no filling of the cyst cavity. The present study retrospectively analyzed 61 cases of symptomatic RCC treated at Chongqing General Hospital (Chongqing, China) between April 2014 and August 2021, and a detailed evaluation was performed on these cases, including clinical symptoms, imaging features, cyst location and characteristics, intraoperative conditions, postoperative outcomes, postoperative complications and long-term follow-up. In the three aspects of clinical symptom relief, postoperative complications and postoperative recurrence rate, this surgical method was analyzed and evaluated. The results suggested that this surgical method is safe and effective for the treatment of symptomatic RCC, which may effectively relieve symptoms and reduce postoperative complications and recurrence.

Keywords: endoscopic endonasal transsphenoidal approach; long-term outcomes; symptomatic Rathke cleft cyst.

Figure 1

Case illustration of patient no. 1. (A-C) Preoperative MRI scans, which are gadolinium-enhanced T1-weighted (A) sagittal image, (B) coronal image and (C) transverse image, reveal an intrasellar RCC. (D-F) Intraoperative images displaying how (D) the cyst at the weakest part of the cyst wall was opened, (E) the contents of the cyst were removed by a curette and (F) the residual cyst contents were aspirated by an aspirator. (G-I) Postoperative MRI, which are gadolinium-enhanced T1-weighted (G) sagittal image, (H) coronal image and (I) transverse image. The yellow arrow indicates the preoperative RCC and the blue arrow indicates the cystic cavity after the resection of the RCC. RCC, Rathke cleft cyst.

Figure 2

Case illustration of patient no. 2. (A-C) Preoperative MRI scans, which are gadolinium-enhanced T1-weighted (A) sagittal image, (B) coronal image and (C) transverse image, reveal an intra-and supra-sellar RCC. (D-F) Intraoperative images displaying how (D) the cyst at the weakest part of the cyst wall was opened, (E) the contents of the cyst were removed by a curette and (F) the residual cyst contents were aspirated by an aspirator. (G-I) Postoperative MRI, which are gadolinium-enhanced T1-weighted (G) sagittal image, (H) coronal image and (I) transverse image. The yellow arrow indicates the preoperative RCC and the blue arrow indicates the cystic cavity after the resection of the RCC. RCC, Rathke cleft cyst.

Figure 3

Case illustration of patient no. 3. (A-C) Preoperative MRI scans, which are gadolinium-enhanced T1-weighted (A) sagittal image, (B) coronal image and (C) transverse image, reveal a suprasellar RCC. (D-F) Intraoperative images displaying how (D) the cyst at the weakest part of the cyst wall was opened, (E) the contents of the cyst were removed by a curette and (F) the residual cyst contents were aspirated by an aspirator. (G-I) Postoperative MRI, which are gadolinium-enhanced T1-weighted (G) sagittal image, (H) coronal image and (I) transverse image. The yellow arrow indicates the preoperative RCC and the blue arrow indicates the cystic cavity after the resection of the RCC. RCC, Rathke cleft cyst.

Figure 4

Histopathological presentations of Rathke cleft cyst from patients no.1-no.3 (hematoxylin and eosin staining; magnification, x100). (A) Pathological image of case no. 1, in which the arrow indicates pink unstructured cystic fluid. (B) Pathological image of case no. 2, in which the arrow indicates the cyst wall covered with cuboidal epithelium. (C) Pathological image of case no. 3, in which the arrow indicates pink unstructured cystic fluid and slit-like structures are visible.