Combined Frontotemporal Transbasal Approach for the Resection of a Giant Rathke's Cleft Cyst: Operative Video and Technical Nuances

AbstractWe present a case of a giant Rathke's cleft cyst with significant superior extension into the third and right lateral ventricles and lateral extension into the left Sylvian fissure and over the anterior clinoid process. An extended modification of the frontotemporal approach was performed using a combined frontotemporal transbasal approach. This allowed wide exposure to both transsylvian and subfrontal corridors to the retrochiasmatic space. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, microdissection of the tumor, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient was neurologically intact with improved visual acuity. In summary, the combined frontotemporal transbasal approach is an important strategy in the armamentarium for the surgical management of giant Rathke's cleft cysts.The link to the video can be found at: https://youtu.be/UjhnUZVi03I.

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Trans-sphenoidal Removal of a Rathke's Cleft Cyst

Neurosurgery ◽

10.1227/00006123-197901000-00013 ◽

1979 ◽

Vol 4 (1) ◽

pp. 63-65 ◽

Cited By ~ 16

Author(s):

Lucas J. Martinez ◽

Jewell L. Osterholm ◽

Richard G. Berry ◽

Francis K. Lee ◽

Norman J. Schatz

Keyword(s):

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Partial Removal ◽

Rathke's Cleft Cysts ◽

Radical Removal ◽

Rathke's Cleft ◽

Suprasellar Extension ◽

Visual Disturbances

Abstract Symptomatic Rathke's cleft cysts are uncommon. We present a case with suprasellar extension manifested by hypopituitarism and visual disturbances. The treatment was trans-sphenoidal evacuation and partial removal of the capsule. We suggest that the trans-sphenoidal approach to these lesions is usually adequate and that radical removal of the capsule is not necessary.

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One-piece Orbitozygomatic Craniotomy for Resection of Rathke's Cleft Cyst: Operative Video

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1620277 ◽

2018 ◽

Vol 79 (S 02) ◽

pp. S211-S212

Author(s):

Rimal Dossani ◽

Devi Patra ◽

Christopher Storey ◽

Piyush Kalakoti ◽

Hai Sun

Keyword(s):

Carotid Bifurcation ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Optic Nerves ◽

Postoperative Mri ◽

Normal Pituitary Gland ◽

Safe Strategy ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft ◽

Suprasellar Extension

Objective The video stars orbitozygomatic resection of Rathke's cleft cyst with suprasellar extension in a 37-year-old male patient presenting with severe headaches and bitemporal hemianopia. Clinical and radiological characteristics along with surgical technique (positioning, bony opening, surgical dissection and debulking, closure), histopathology, and postoperative course are described. Methods Preoperative MRI demonstrated a noncontrast-enhancing cystic lesion in the sella with suprasellar extension causing compression of both optic nerves. A one-piece orbitozygomatic craniotomy was performed. The tumor was encountered in the interoptic space. First, the cyst was decompressed and fluid appearing like motor oil was aspirated. Both optic nerves were decompressed and dissected free from the cyst wall. Intraoperatively, the most challenging aspect was separating the tumor from surrounding vascular structures, including bilateral A1 arteries and the left carotid bifurcation. A combination of sharp and blunt dissection was utilized to free the tumor from adhesions to critical neurovascular structures. Once freed, the suprasellar aspect of the tumor was mobilized into the operative cavity and debulked. Finally, the sellar component of the tumor was removed all the way down to the sellar floor. Postoperative MRI demonstrated decompressed bilateral optic nerves with an intact pituitary stalk with preservation of normal pituitary gland. Histopathology identified pathognomonic features consistent with diagnosis of Rathke's cleft cyst, including flattened ciliated epithelium and presence of Rathke's cleft remnants. Results Postoperatively, bilateral improvement in vision was noted with transient diabetes insipidus. Patient was discharged home on postoperative day 4. Conclusion A one-piece orbitozygomatic craniotomy is an effective and safe strategy for resection of Rathke's cleft cysts with suprasellar extension.The link to the video can be found at: https://youtu.be/-Yqtcd2gLSs.

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Transsphenoidal Endoscopic Approach in the Treatment of Rathke's Cleft Cyst

Neurosurgery ◽

10.1227/01.neu.0000144824.80046.1f ◽

2005 ◽

Vol 56 (1) ◽

pp. 124-129 ◽

Cited By ~ 66

Author(s):

Giorgio Frank ◽

Vittorio Sciarretta ◽

Diego Mazzatenta ◽

Giovanni Farneti ◽

Giovanni Carlo Modugno ◽

...

Keyword(s):

Diabetes Insipidus ◽

Visual Impairment ◽

Endoscopic Approach ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Invasive Approach ◽

Pituitary Dysfunction ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

Abstract OBJECTIVE: In this study, the usefulness of the transsphenoidal endoscopic approach in the treatment of a Rathke's cleft cyst is reported. METHODS: Between June 1998 and December 2002, 22 patients affected by sellar-suprasellar Rathke's cleft cysts were treated using a transsphenoidal endoscopic approach. Fourteen patients experienced pituitary dysfunction (64%), five experienced visual impairment (23%), and three reported headaches (14%). RESULTS: The patient follow-up ranged from 8 to 60 months (mean, 33 mo). Pituitary function was restored only in the four patients with hyperprolactinemia, whereas visual impairment and headache improved in all patients. However, when present before surgery, hypopituitarism was unaffected by surgery. Two patients experienced permanent diabetes insipidus (one of them before surgery). Only one recurrence was observed in a 13-year-old girl at 12 months after surgery, and it was treated using a new transsphenoidal endoscopic approach. CONCLUSION: The transsphenoidal endoscopic approach represents a straightforward and mini-invasive approach for the drainage and biopsy of a Rathke's cleft cyst.

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Symptomatic Rathke's Cleft Cysts Located Entirely in the Suprasellar Region: Review of Diagnosis, Management, and Pathogenesis

Neurosurgery ◽

10.1227/00006123-198506000-00005 ◽

1985 ◽

Vol 16 (6) ◽

pp. 766-772 ◽

Cited By ~ 58

Author(s):

Daniel L. Barrow ◽

Robert H. Spector ◽

Yoshio Takei ◽

George T. Tindall

Keyword(s):

Surgical Treatment ◽

Optic Chiasm ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Hypothalamic Dysfunction ◽

Suprasellar Region ◽

Rathke's Cleft Cysts ◽

Metrizamide Cisternography ◽

Rathke's Cleft

Abstract Three cases of an entirely suprasellar symptomatic Rathke's cleft cyst, two of which were associated with normal sella turcicas, are reported. In all cases, the cysts caused compression of the optic chiasm, and two produced hypothalamic dysfunction. The diagnosis of these entirely suprasellar masses was enhanced by metrizamide cisternography. Two cases were treated by frontal craniotomy and one was treated transsphenoidally, with good results in all cases. The radiology, pathology, and surgical treatment of these unusual cases is presented. An embryological pathogenesis for the occurrence of an entirely suprasellar Rathke's cleft cyst is discussed.

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Recurrence of Rathke’s Cleft Cysts Based on Gross Total Resection of Cyst Wall: A Meta-analysis

10.1055/s-0040-1702442 ◽

2020 ◽

Author(s):

Victor Lu ◽

Avital Perry ◽

Christopher Graffeo ◽

Krishnan Ravindran ◽

Jamie Van Gompel

Keyword(s):

Cyst Wall ◽

Meta Analysis ◽

Gross Total Resection ◽

Total Resection ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

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Rathke's cleft cyst mimiking pituitary apoplexy: a case report

Endocrine Abstracts ◽

10.1530/endoabs.56.p765 ◽

2018 ◽

Author(s):

Ines Barka ◽

Faiza Bensmaine ◽

Moctar Bah ◽

Clara Bouche ◽

Jean Francois Gautier

Keyword(s):

Case Report ◽

Pituitary Apoplexy ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Rathke's Cleft

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Rathke’s cleft cyst infections and pituitary abscesses: case series and review of the literature

Pituitary ◽

10.1007/s11102-020-01115-2 ◽

2021 ◽

Author(s):

F. Aranda ◽

R. García ◽

F. J. Guarda ◽

F. Nilo ◽

J. P. Cruz ◽

...

Keyword(s):

Case Series ◽

Rathke’S Cleft Cyst ◽

Review Of The Literature ◽

Rathke's Cleft Cyst ◽

Rathke's Cleft

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Relationship between Recurrence Rates of Rathke's Cleft Cysts and Surgical Approaches to Sellar Reconstruction

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701223 ◽

2020 ◽

Author(s):

Rebecca Limb ◽

James King

Keyword(s):

Recurrence Rate ◽

Case Series ◽

Redo Surgery ◽

Rathke’S Cleft Cyst ◽

Recurrence Rates ◽

Rathke's Cleft Cyst ◽

Study Objective ◽

Cyst Recurrence ◽

Rathke's Cleft ◽

Sellar Floor

Abstract Study Objective The main purpose of this article is to address the question of whether reconstructing the sellar floor following Rathke's cleft cyst excision results in increased rates of recurrence. Methods and Design A retrospective case series was compiled from medical records and radiological investigations at a single institution over a time period spanning 25 years. Episodes of cyst recurrence were determined from magnetic resonance imaging scans and outpatient encounters. Details regarding surgical procedure and techniques were obtained from operation notes. Perioperative morbidity was also recorded. Results Twenty-three adult patients were treated surgically for a Rathke's cleft cyst at the study institution between 1992 and 2017. The overall cyst recurrence rate was 48%, with 39% of all patients requiring redo surgery within the timeframe of the study. The mean time to redo surgery for recurrence was 4 years. Cyst recurrence rates were 57% postmicroscopic procedures, and 26% postendoscopic procedures (p = 0.148). In the nonreconstructed group, the recurrence rate was 17%, and in the reconstructed group the recurrence rate was 41% (p = 0.3792). Complications arising after nonreconstructive procedures were delayed cerebrospinal fluid rhinorrhea, pneumocephaly, and multiple episodes of meningitis. All these patients required return to theater for secondary reconstruction of the pituitary fossa floor. Conclusion The results of this small study suggest that reconstruction of the sellar floor, and microscopic rather than endoscopic techniques, may be associated with a higher rate of Rathke's cleft cyst recurrence. However, these trends did not reach statistical significance. Patients undergoing nonreconstructive procedures may be more prone to certain postoperative complications.

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