scholarly journals Endoscopic Transsphenoidal Cisternostomy for Nonneoplastic Sellar Cysts

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Yukai Su ◽  
Yudo Ishii ◽  
Chien-Min Lin ◽  
Shigeyuki Tahara ◽  
Akira Teramoto ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Clinical Presentation ◽  
Arachnoid Cysts ◽  
Invasive Approach ◽  
Csf Fistula ◽  
Pituitary Dysfunction ◽  
Operative Complications ◽  
Rathke's Cleft Cysts ◽  
Fistula Rate ◽  
Rathke's Cleft

Background and Importance. Sellar arachnoid cysts and Rathke’s cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant.Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke’s cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable.Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.

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

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 124-129 ◽  
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.

Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts

1991 ◽  
Vol 74 (4) ◽  
pp. 535-544 ◽  
Author(s):  
Joseph L. Voelker ◽  
Robert L. Campbell ◽  
Jans Muller
Keyword(s):  
Cystic Mass ◽  
Content Type ◽  
Pituitary Dysfunction ◽  
Recommended Treatment ◽  
Average Patient ◽  
Rathke's Cleft Cysts ◽  
Male Patients ◽  
Rathke's Cleft ◽  
Cyst Lining ◽  
Symptoms And Signs

✓ The clinical, radiographic, and pathological findings in 155 patients with symptomatic Rathke's cleft cysts are discussed. Eight patients were treated by the authors and 147 were collected in a review of the literature. This lesion occurred more often in female than male patients by a 2:1 margin, and the mean age at presentation was 38 years. The average patient had been symptomatic for nearly 3 years at the time of treatment, with the most common symptoms and signs being pituitary dysfunction, visual disturbances, and headaches. Affected children generally were pituitary dwarfs. The sella was enlarged in 80% of cases, and the cyst was situated in both an intrasellar and a suprasellar location in 71%. Computerized tomography revealed a low-density cystic mass with capsular enhancement in one-half of the cases. A variable appearance was seen with magnetic resonance imaging. Partial excision and drainage of the cyst by the transsphenoidal approach is the recommended treatment, as the recurrence rate is low. Most symptoms and signs improved or resolved following surgery with the exception of hypopituitarism and diabetes insipidus. The cyst lining was usually composed of ciliated cuboidal or columnar epithelium. Theories as to the origin of Rathke's cleft cysts are also discussed.

Rathke's cleft cysts and arachnoid cysts

2021 ◽  
pp. 551-556
Author(s):  
Vincent Dodson ◽  
Jean Anderson Eloy ◽  
James K. Liu
Keyword(s):  
Arachnoid Cysts ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Endonasal Endoscopic Fenestration of Rathke's Cleft Cysts: Whether to Leave the Fenestration Open or Closed?

2019 ◽  
Author(s):  
Leopold Arko ◽  
Jonathan C.M. Lee ◽  
Saniya Godil ◽  
Samuel Z. Hanz ◽  
Vijay K. Anand ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Open Group ◽  
Csf Leak ◽  
Closure Rate ◽  
Endoscopic Endonasal ◽  
Closed Group ◽  
Rathke's Cleft Cysts ◽  
Watertight Closure ◽  
Rathke's Cleft ◽  
Csf Leaks

Abstract Introduction Rathke's cleft cysts (RCC) are generally treated with transsphenoidal fenestration and cyst drainage. If no cerebrospinal fluid (CSF) leak is created, the fenestration can be left open. If CSF is encountered, a watertight closure must be created to prevent postoperative CSF leak, though sellar closure has theoretically been linked with higher recurrence rate. In this study, we investigate the relationship between sellar closure, rate of postoperative CSF leak, and RCC recurrence. Methods Retrospective review of a prospective database of all endoscopic endonasal RCC fenestrations and cases were divided based on closure. The “open” group included patients who underwent fenestration of the RCC, whereas the “closed” group included patients whose RCC was treated with fat and a rigid buttress ± a nasoseptal flap. The rate of intra- and postoperative CSF leak and radiographic recurrence was determined. Results The closed group had a higher rate of suprasellar extension (odds ratio [OR]: 8.0, p = 0.032) and intraoperative CSF leak (p ≤ 0.001). There were 54.8% intraoperative CSF leaks and no postoperative CSF leaks. Radiologic recurrence rate for the closed group (35.0%) was three times higher than the open group (9.1%; risk ratio [RR] = 3.85, p = 0.203), but not powered to show significance. None of the radiologic recurrences required reoperation. Conclusion Maintaining a patent fenestration between an RCC and the sphenoid sinus is important in reducing the rate of radiographic recurrence. Closure of the fenestration may be required to prevent CSF leak. While closure increases the rate of radiographic recurrence, reoperation for recurrent RCC is still an uncommon event.

Rathke’s Cleft Cysts

2018 ◽  
Author(s):  
Ian A. Buchanan ◽  
Gabriel Zada
Keyword(s):  
Complete Resection ◽  
Management Technique ◽  
Visual Deficits ◽  
Rathke Cleft Cyst ◽  
Pituitary Dysfunction ◽  
Rathke's Cleft Cysts ◽  
Transphenoidal Approach ◽  
Autopsy Specimens ◽  
Rathke's Cleft ◽  
Cyst Fenestration

Cystic lesions involving the sella have a distinct differential diagnosis including Rathke cleft cyst, cystic pituitary adenoma, craniopharyngioma, arachnoid cyst, and epidermoid among other entities. Workup includes not only cranial imaging but also endocrine evaluation for pituitary dysfunction and ophthalmologic evaluation to assess for visual deficits that may not be immediately apparent to the patient at presentation. Rathke cleft cysts are common and may be found in 20% of autopsy specimens. However, symptomatic Rathke cleft cysts are rare, and surgical decisions should be made judiciously based on preoperative symptoms and workup. Endonasal transphenoidal approach for cyst fenestration is a common surgical management technique for symptomatic lesions. Complete resection of the Rathke cleft cyst wall is not required.

Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives?

1994 ◽  
Vol 80 (6) ◽  
pp. 1018-1025 ◽  
Author(s):  
Michael J. Harrison ◽  
Susan Morgello ◽  
Kalmon D. Post
Keyword(s):  
Clinical Presentation ◽  
Cystic Lesions ◽  
Content Type ◽  
Epidermoid Cysts ◽  
Parasellar Region ◽  
Histological Criteria ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Epithelial Lesions ◽  
Fine Print

✓ Cystic epithelial lesions of the sellar and parasellar region are classified on the basis of histology and location into Rathke's cleft cysts, epithelial cysts, epidermoid cysts, dermoid cysts, and craniopharyngiomas. A retrospective review of the clinical presentation, radiological findings, and histology was performed on 19 such lesions, and a survey of the literature pertinent to the classification, clinical presentation, and embryology of these lesions was conducted. Presentation was nonspecific and not predictive of histology. Imaging studies were generally useful in distinguishing these tumors, with the exception of Rathke's cleft cysts, suprasellar epidermoid cysts, and craniopharyngiomas, which frequently could not be differentiated. On microscopic examination, most lesions fit into distinct categories; however, overlap was common among all and some could not be definitively categorized by histological criteria. Evidence supportive of an ectodermal ancestry for sellar and parasellar epithelial-lined cystic lesions is presented. Based on the current findings and a review of the literature, it is suggested that these lesions represent a continuum of ectodermally derived cystic epithelial lesions.

Treatment Outcomes of Rathke’s Cleft Cysts Managed with Marsupialization

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Edward Kuan ◽  
Frederick Yoo ◽  
Marvin Bergsneider ◽  
Marilene Wang
Keyword(s):  
Treatment Outcomes ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

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

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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