Recurrent Rathke's Cleft Cysts: Incidence and Surgical Management in a Tertiary Pituitary Center over 2 Decades

2018 ◽  
Vol 16 (6) ◽  
pp. 675-684 ◽  
Author(s):  
Michelle A Wedemeyer ◽  
Michelle Lin ◽  
Vance L Fredrickson ◽  
Anush Arakelyan ◽  
Daniel Bradley ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vision Loss ◽  
Squamous Metaplasia ◽  
Cerebrospinal Fluid Leak ◽  
Pathological Examination ◽  
Limited Data ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Fluid Leak

Abstract Background Limited data exist pertaining to outcomes following surgery for recurrent Rathke's cleft cysts (RCC). Objective To determine treatment outcomes in patients undergoing reoperation for recurrent or residual RCCs. Methods A retrospective analysis of 112 consecutive RCC operations in 109 patients between 1995 and 2017 was conducted. Results Eighteen patients underwent 21 RCC reoperations with a mean follow-up of 58 mo. Patient symptoms prior to reoperation included headaches (14, 66.7%) and vision loss (12, 57.1%). Thirteen of 18 patients (72.2%) required hormone supplementation prior to reoperation including 5 with diabetes insipidus (DI). Mean RCC diameter was 16 mm and 76% had suprasellar extension. Compared to index RCC cases, intraoperative cerebrospinal fluid leak repair was more common in reoperation cases (15/21, 71% vs 43/91, 47%, P = .05). There was 1 carotid artery injury without neurological sequelae, and 2 postoperative cerebrospinal fluid (CSF) leaks (9.5%). Rates of transient hyponatremia (3/10, 30% vs 4/91, 4.4%, P = .04) and transient DI (5/10, 50% vs 17/91, 18.7%, P = .04) were higher in the reoperation vs index group. Improved headaches and vision were reported in 4/12 (33%) and 8/12 (61.5%) of RCC reoperation patients, respectively. Two patients developed new permanent DI. A higher proportion of reoperation patients had RCC squamous metaplasia (24% vs 5.4%, P = .02) or wall inflammation (42.9% vs 2.2%, P < .001) on pathological examination. CONCLUSION Reoperation for RCCs is generally safe at tertiary pituitary centers and often results in improved vision. Hypopituitarism is less likely to improve following reoperation for recurrent RCCs. Several histopathological features may help characterize “atypical RCCs” with a higher likelihood of recurrence/progression.

EXTENDED ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL APPROACH FOR THE REMOVAL OF SUPRASELLAR TUMORS

Neurosurgery ◽  
2007 ◽  
Vol 60 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Enrico de Divitiis ◽  
Luigi Maria Cavallo ◽  
Paolo Cappabianca ◽  
Felice Esposito
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenomas ◽  
Cerebrospinal Fluid Leak ◽  
Complete Removal ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal ◽  
Rathke's Cleft Cysts ◽  
Tuberculum Sellae ◽  
Rathke's Cleft ◽  
Fluid Leak

Abstract OBJECTIVE The widespread use of the endoscope in transsphenoidal pituitary surgery has recently contributed to the extension of the approach beyond the tuberculum sellae and planum sphenoidale for the management of lesions located in the suprasellar area, either with an endoscope-assisted or purely endoscopic technique. Based on our previous experience with more than 450 standard endoscopic transsphenoidal operations, we have retrospectively evaluated the effectiveness of the extended endoscopic endonasal transsphenoidal approach in the management of lesions mainly located in the suprasellar area. METHODS Between January 2004 and December 2005, 20 consecutive patients underwent extended endoscopic endonasal transsphenoidal surgery for a total of 21 procedures. The series consisted of seven pituitary adenomas, seven craniopharyngiomas, three suprasellar Rathke's cleft cysts, two tuberculum sellae meningiomas, and one pilocytic astrocytoma of the chiasm. RESULTS Tumor removal, as assessed by postoperative magnetic resonance imaging, revealed complete removal of the lesion in four out of seven pituitary adenomas, five out of seven craniopharyngiomas, three out of three Rathke's cleft cysts, and two out of two tuberculum sellae meningiomas. One patient (5%) with craniopharyngioma had a postoperative cerebrospinal fluid leak that required reoperation. The same patient experienced a sphenoid mycosis, which was treated with medical therapy. Some specific conditions associated with the anatomy of the surgical route, as well as to the morphology of the lesion, have resulted to condition the feasibility of the approach. CONCLUSION Small and medium sized suprasellar lesions located in the midline, with or without a limited parasellar extension and without involvement of vascular structures, seem amenable to be resected through such extended endoscopic transsphenoidal approach. Improvements in closure techniques and the use of new materials and surgical glues seem to significantly reduce the postoperative cerebrospinal fluid leak rate and meningitis.

scholarly journals Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

2019 ◽  
Vol 81 (05) ◽  
pp. 553-561
Author(s):  
Gülpembe Bozkurt ◽  
Mario Turri-Zanoni ◽  
Elisa Coden ◽  
Federico Russo ◽  
Hassan Ahmed Elhassan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Dry Eye ◽  
Sphenoid Sinus ◽  
Cerebrospinal Fluid Leak ◽  
Significant Morbidity ◽  
Endoscopic Endonasal ◽  
Lateral Recess ◽  
Fluid Leak ◽  
Extensive Surgery

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure.Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach.Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients.Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak

2008 ◽  
Vol 123 (1) ◽  
pp. 145-147 ◽  
Author(s):  
J K Anverali ◽  
A A Hassaan ◽  
H A Saleh
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
World Literature ◽  
Cerebrospinal Fluid Leak ◽  
Lumbar Drain ◽  
Alternative Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:To describe a previously unreported case of repair of a lateral frontal sinus cerebrospinal fluid leak, using the endoscopic modified Lothrop procedure.Method:Case report of new technique, with reference to the world literature.Results:An effective endoscopic, transnasal repair of a lateral frontal sinus cerebrospinal fluid leak was achieved in a 60-year-old man. The defect was closed with fat, fascia lata and free mucosal grafts. The left nasal cavity was packed and a lumbar drain left in situ post-operatively. The drain and packs were removed one week later and the patient discharged with no complications, and no recurrence at 12 months' follow up.Conclusion:Such cerebrospinal fluid leaks have traditionally been repaired using an external approach with osteoplastic flaps and obliteration of the sinus. We highlight the endoscopic modified Lothrop technique as an effective alternative approach to repair of cerebrospinal fluid leaks in poorly accessible areas of the frontal sinus.

Management of intra-operative cerebrospinal fluid leak following endoscopic trans-sphenoidal pituitary surgery

2010 ◽  
Vol 125 (3) ◽  
pp. 311-313 ◽  
Author(s):  
C G L Hobbs ◽  
A Darr ◽  
W V Carlin
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Pituitary Surgery ◽  
Gelatin Sponge ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Cerebrospinal Fluid Leaks ◽  
Low Incidence ◽  
Fluid Leak

AbstractObjective:Cerebrospinal fluid leakage is the most common complication of endoscopic trans-sphenoidal pituitary surgery. However, there is no uniformly accepted way of managing this complication when it occurs intra-operatively. This paper describes a quick, simple technique, involving layered fibrin glue and gelatin sponge, which does not compromise post-operative patient follow up.Method:Retrospective review of all endoscopic pituitary surgery cases conducted at a single institution since the introduction of this technique in 2002.Results:A total of 120 endoscopic pituitary operations were performed (96 primary procedures and 24 revisions). All intra-operative cerebrospinal fluid leaks were managed using the described method, with a failure rate of 3.6 per cent. The overall post-operative leakage rate was 1.7 per cent.Conclusion:This simple, conservative technique avoids the need for further dissection and the use of non-absorbable foreign material, and has a low incidence of post-operative cerebrospinal fluid leakage.

scholarly journals Surgical Approach to Frontal and Ethmoid Sinus Osteomas: The Experience of 2 Metropolitan Italian Hospitals

2021 ◽  
pp. 014556132110168
Author(s):  
Antonio Minni ◽  
Luca Roncoroni ◽  
Fabrizio Cialente ◽  
Federica Zoccali ◽  
Andrea Colizza ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Approach ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Endoscopic Approach ◽  
Open Approach ◽  
The Mean ◽  
Ethmoid Sinuses ◽  
Fluid Leak

Objectives: The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian hospitals between 2012 and 2019. Methods: A retrospective chart review of cases of frontal and ethmoid osteomas from the Ca’ Granda Niguarda Hospital of Milan and the Policlinico Umberto I University Hospital of Rome was performed. All patients underwent preoperative computed tomography and, when orbital or intracranial extension was suspected, magnetic resonance imaging. Surgical treatment was performed according to Chiu classification. Results: A total of 38 cases of frontal and ethmoid sinus osteomas were included in the study; 22 patients were men and 16 were women. The mean age at diagnosis was 49 years. Seven (18.4%) patients were treated using an open approach; 3 (7.9%) patients underwent open and endoscopic approach; the remaining 28 (73.7%) patients were treated with endoscopic approach. Seven (18.4%) patients had a cerebrospinal fluid leak intraoperatively and were treated with the placement of tissue graft through the defect. The mean follow-up time was 18 months; no recurrence was observed at 12-month follow-up. Conclusion: Osteomas of the frontal and ethmoid sinuses can be treated using different techniques, mostly endoscopically. The choice of surgical approach (endoscopic vs open) depends on the location and size of the osteoma, anatomical size, characteristic of the sinus, surgeon’s experience, and available existing technical facilities. Cerebrospinal fluid leak is a possible complication of surgery.

Cerebrospinal fluid leak from lateral orbit during exenteration for mucormycosis

2020 ◽  
Vol 13 (9) ◽  
pp. e237575
Author(s):  
Kanika Arora ◽  
Aditi Mehta ◽  
Ramandeep Singh Virk ◽  
Manu Saini
Keyword(s):  
Cerebrospinal Fluid ◽  
Vision Loss ◽  
Vascular Occlusion ◽  
Cerebrospinal Fluid Leak ◽  
Sudden Onset ◽  
Csf Leak ◽  
Orbital Apex ◽  
Orbital Wall ◽  
Retinal Vascular Occlusion ◽  
Fluid Leak

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.

Spontaneous Nasal Cerebrospinal Fluid Leak Repaired With Single-Layer Mucoperichondrial Graft: Long-term Results

2020 ◽  
Vol 34 (3) ◽  
pp. 382-387
Author(s):  
Matteo Alicandri-Ciufelli ◽  
Matteo Fermi ◽  
Maria Silvia Rosa ◽  
Massimiliano Garzaro ◽  
Livio Presutti
Keyword(s):  
Cerebrospinal Fluid ◽  
Single Layer ◽  
Cerebrospinal Fluid Leak ◽  
Long Term Results ◽  
Consecutive Series ◽  
Free Graft ◽  
Clinical Records ◽  
Fluid Leak

Background Spontaneous cerebrospinal fluid leak (sCSFL) has been historically related to obesity and elevated intracranial pressure (ICP), with a lower rate of success of endoscopic repair reported in the literature. Moreover, defects related to this condition have been largely repaired with multilayer reconstructions and pedicled flaps. Long-term postoperative results have not been appropriately discussed yet. Objective The aim of this study is to investigate the outcome of a cohort of patients treated with single-layer mucoperichondrial graft. Methods A retrospective review of clinical records of a consecutive series of patients who underwent endonasal endoscopic surgery for sCSFL was carried out at a tertiary care referral center for skull base pathologies. All patients underwent reconstruction with single-layer mucoperichondrial free graft. Local flap failures and postoperative outcomes, in terms of recurrence of sCSFL or brain herniation, were registered. Results Neither intraoperative nor perioperative complications were reported. Definitive closure was achieved in 27 of 29 (93%) patients after the first attempt, while in 2 cases, a revision surgery was required. In both of these, an inadequate position of the graft was detected and was repaired likewise with the same mucoperichondrial graft. None of the patients required postoperative lumbar drain placement. After a median follow-up period of 57 months, only 1 patient developed a meningocele without CSFL about 2 years after surgery at the contralateral lateral recess of the sphenoid sinus. None of the patients reported symptoms referable to elevated ICP nor underwent ventricular derivation. Conclusions Single-layered mucoperichondrial free graft was safe and effective in the majority of the examined patients. In 7% of the study population, a surgical revision was necessary due to local failure of the graft. However, during long-term follow-up, only 1 case of recurrent meningocele without CSFL was reported in a patient who presented borderline ICP.

scholarly journals The long-term recurrence of Rathke's cleft cysts as predicted by histology but not by surgical procedure

2016 ◽  
Vol 125 (4) ◽  
pp. 1002-1007 ◽  
Author(s):  
Yasuyuki Kinoshita ◽  
Atsushi Tominaga ◽  
Satoshi Usui ◽  
Kazunori Arita ◽  
Tetsuhiko Sakoguchi ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Squamous Metaplasia ◽  
Visual Disturbance ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Term Monitoring

OBJECTIVE Patients with symptomatic Rathke's cleft cysts (RCCs) managed by surgical treatment often experience recurrence. The authors attempted to clarify the outcome of surgically treated RCCs over a long-term follow-up period. METHODS Ninety-one consecutive RCC patients with a follow-up period of more than 12 months (mean 80.2 months, range 12–297 months) were retrospectively studied. The authors examined the clinical features and postoperative course of patients who experienced a reaccumulation of cyst contents visible on MRI after the initial surgery, and they investigated data from the patients who underwent reoperation for symptomatic recurrent RCCs. RESULTS Reaccumulation of cyst contents occurred in 36 patients (39.6%). In 34 of these patients, a reaccumulation occurred in the first 5 years after surgery. The initial cysts in these patients were most often large, with squamous metaplasia in the cyst walls. Thirteen patients (14.3%) with recurrent symptoms underwent a reoperation, and 10 of the 13 patients had a reaccumulation of RCCs within the 1st year after surgery. The reoperations were performed in the 1st year (61.5%) or several years later (23.1%). Patients were likely to initially have had a visual disturbance and the cyst walls likely included squamous metaplasia. However, no association was observed between the incidence of reaccumulation/reoperation of RCCs and the surgical procedure for RCCs. CONCLUSIONS The reaccumulation rate of RCC is high in the long-term period, and it is associated with the histological findings but not with the surgical procedure. Long-term monitoring, for a period of at least 5 years, should therefore be conducted to identify and assess any RCC reaccumulation.

A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures: detailed clinical and radiological follow-up

2011 ◽  
Vol 35 (2) ◽  
pp. 227-238 ◽  
Author(s):  
Camillo Sherif ◽  
Antonio Di Ieva ◽  
Daniel Gibson ◽  
Bita Pakrah-Bodingbauer ◽  
Georg Widhalm ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Management Algorithm ◽  
Fluid Leak

Early Repair of Myelomeningocele and Simultaneous Insertion of Ventriculoperitonal Shunt: Technique and Results

Neurosurgery ◽  
1987 ◽  
Vol 20 (1) ◽  
pp. 21-23 ◽  
Author(s):  
Malek Y. Hubballah ◽  
Harold J. Hoffman
Keyword(s):  
Cerebrospinal Fluid ◽  
Psychosocial Development ◽  
Ventriculoperitoneal Shunt ◽  
Neuropsychological Testing ◽  
Cerebrospinal Fluid Leak ◽  
Sick Children ◽  
Myelomeningocele Repair ◽  
Fluid Leak ◽  
Shunt Infections

Abstract During the years 1975 to 1985, 10 patients underwent simultaneous repair of myelomeningocele and insertion of a ventriculoperitoneal shunt at the Hospital for Sick Children in Toronto. The technique for carrying out these procedures in the same operative setting will be described. None of the patients developed shunt infections or myelomeningocele repair breakdown in the follow-up period of 1 to 9 years. One patient died 9 days after operation secondary to aspiration. The remaining patients underwent neuropsychological testing during their follow-up periods and over 70% were found to have normal or slightly below normal intelligence and psychosocial development. The technique of simultaneous repair of a myelomeningocele and insertion of a ventriculoperitoneal shunt in infants with a myelomeningocele and concomitant hydrocephalus overt at birth is safe and should be carried out to decrease the risk of myelomeningocele repair breakdown and cerebrospinal fluid leak in such patients.

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