Tension Pneumocyst after Transsphenoidal Surgery for Rathke's Cleft Cyst: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 960-963 ◽  
Author(s):  
A. Celal Iplikcioglu ◽  
Sirzat Bek ◽  
Kerem Bıkmaz ◽  
Kahan Basocak
Keyword(s):  
Transsphenoidal Surgery ◽  
Emergency Service ◽  
Rare Complication ◽  
Fat Graft ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Tension Pneumocephalus ◽  
Trapped Air ◽  
Rathke's Cleft ◽  
Immediate Reoperation

Abstract OBJECTIVE AND IMPORTANCE Tension pneumocephalus is a rare but well-described complication of transsphenoidal surgery. It is usually associated with postoperative cerebrospinal fluid fistulae causing lower intracranial pressure, with air located in the subdural, subarachnoid, or intraventricular space. We report a case of suprasellar tension pneumocyst that caused visual deterioration to develop after an operation for a Rathke's cleft cyst. Only one similar case has been reported previously. CLINICAL PRESENTATION A 54-year-old woman with a cystic sellar-suprasellar mass compressing the chiasm was operated on via a standard transsphenoidal approach. The intraoperative diagnosis was Rathke's cleft cyst, and the floor of sella was left open to avoid recurrence. The sphenoid sinus was filled with a fat graft, and the rostrum of the sphenoid was reconstructed with a bone fragment. The patient's postoperative course was uneventful, and her vision improved. Ten days after discharge, the patient was readmitted to the emergency service with headache and visual impairment. Emergent computed tomography confirmed a suprasellar tension pneumocyst. INTERVENTION The patient underwent immediate reoperation via an endonasal endoscopic approach. After the trapped air was evacuated, the sella was closed with fascia lata and muscle using fibrin glue. The patient's vision improved postoperatively. CONCLUSION Suprasellar tension pneumocyst is an extremely rare complication of transsphenoidal surgery. To avoid this complication, the sellar floor should be repaired in a watertight fashion, and patients should be instructed to avoid blowing the nose, sneezing, straining, and coughing postoperatively.

Endoscopic transsphenoidal surgery of Rathke’s cleft cyst

2015 ◽  
Vol 22 (1) ◽  
pp. 149-154 ◽  
Author(s):  
Zachary S. Mendelson ◽  
Qasim Husain ◽  
Vivek V. Kanumuri ◽  
Jean Anderson Eloy ◽  
James K. Liu
Keyword(s):  
Transsphenoidal Surgery ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Endoscopic Transsphenoidal Surgery ◽  
Rathke's Cleft

Rathke’s cleft cyst recurrence after transsphenoidal surgery: A meta-analysis of 1151 cases

2014 ◽  
Vol 21 (3) ◽  
pp. 378-385 ◽  
Author(s):  
Zachary S. Mendelson ◽  
Qasim Husain ◽  
Sedeek Elmoursi ◽  
Peter F. Svider ◽  
Jean Anderson Eloy ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Meta Analysis ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Cyst Recurrence ◽  
Rathke's Cleft

scholarly journals Surgical Treatment of a Calcified Rathke's Cleft Cyst With Endoscopic Extended Transsphenoidal Surgery

2011 ◽  
Vol 51 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Takao ARAI ◽  
Kentaro HORIGUCHI ◽  
Naokatsu SAEKI ◽  
Hidehiro OKA ◽  
Takatoshi SAITO ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Transsphenoidal Surgery ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Rathke's Cleft

scholarly journals Diagnostic Significance of Intracystic Nodules on MRI in Rathke’s Cleft Cyst

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Shou-sen Wang ◽  
De-yong Xiao ◽  
Ying-hao Yu ◽  
Jun-jie Jing ◽  
Lin Zhao ◽  
...  
Keyword(s):  
Medical Records ◽  
Transsphenoidal Surgery ◽  
Rathke’S Cleft Cyst ◽  
Pathological Findings ◽  
Rathke's Cleft Cyst ◽  
Diagnostic Significance ◽  
Postoperative Mri ◽  
Rathke's Cleft ◽  
First Time ◽  
T2 Weighted Images

Background and Purpose. To explore strategies for the diagnosis and treatment of Rathke’s cleft cyst (RCC).Methods. The medical records of 24 patients with sellar RCC were retrospectively reviewed. Two patients had concomitant pituitary adenoma, 2 underwent transcranial surgery, and 22 underwent transsphenoidal surgery. The clinical features, especially the findings of intracystic nodules on MRI, were evaluated and compared with the pathological findings.Results. Preoperatively, only 2 patients were diagnosed with RCC or suspected RCC. Pre- and postoperative MRI images revealed 10 intracystic nodules in 9 (37.5%) patients. Two nodules had bull's eyelike changes. The signal intensity of the intracystic nodules varied on T1- and T2-weighted images. Not all nodules on T2-weighted images were visualized. Postoperative MRI revealed recurrence or residual lesion in 5 patients; none had new symptoms and a second surgery was not required.Conclusions. Identifying intracystic nodules is important in patients with sellar cystic lesions. Bull’s eyelike change in an intracystic nodule on MRI, which is reported here for the first time, potentially might have value for confirming the diagnosis.

scholarly journals Endoscopic Endonasal Resection of Rathke Cleft Cyst with Xanthogranulomatous Change: Two-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael Zhang ◽  
Anil K. Mahavadi ◽  
Michael L. Deftos ◽  
Arshad Ali ◽  
Harminder Singh
Keyword(s):  
Vision Loss ◽  
Peripheral Vision ◽  
Pediatric Population ◽  
Fibrous Tissue ◽  
Fat Graft ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Pathological Subtype ◽  
Cystic Component ◽  
Rathke's Cleft

Abstract Objective Sellar xanthogranulomas (XGAs) are a rare pathological subtype of hypophysitis reflecting a degenerative process of Rathke's cleft cyst with predilection in young adults. While the histological features have been described, there is limited discussion on the technical expectations in surgical management. We present the clinical, radiographic, and surgical features of the third literature-reported XGA in the pediatric population. Setting The patient was a 17-year-old boy who first identified by ophthalmologically confirmed peripheral vision loss. Subsequent endocrine workup identified delayed-onset puberty and hypopituitarism. Magnetic resonance imaging (MRI) showed a nonenhancing 2.6-cm T1 and T2 sellar-based hyperintense mass with suprasellar extension and mass effect on the optic chiasm. A small T1 hypointense encased nodule was also seen (Fig. 1). Consent for resection was obtained. Results Intraoperatively the tumor was firm and adherent, requiring piecemeal removal. Radiofrequency ablation enabled ergonomic debulking and minimize thermal injury (Fig. 2).1 We used initial settings of 25 W, equivalent to 55 W. A cystic component with motor oil–like fluid was encountered and decompressed. The tumor was notably very adherent to the optic nerve and infiltrated the stalk, requiring its truncation. Closure was achieved by fat graft dead space plugging, fascia lata underlay, Medpor gasket seal, and nasoseptal flap. Conclusion Pathology confirmed dense fibrous tissue with features of chronic inflammation, cholesterol clefts, hemosiderin pigment, multinucleate giant cells, and foamy macrophages. Additional cyst wall sampling identified squamous and ciliated epithelial lining, collectively consistent with Rathke's cleft cyst and xanthogranulomatous reaction. These lesions can undergo surgical cure with resection, most commonly by transsphenoidal approach.The link to the video can be found at: https://youtu.be/S2n5iQ3aFgc.

Transsphenoidal surgery for Rathke’s cleft cyst can reduce headache severity and frequency

Pituitary ◽  
2015 ◽  
Vol 19 (1) ◽  
pp. 57-64 ◽  
Author(s):  
David J. Cote ◽  
Benjamin D. Besasie ◽  
M. Maher Hulou ◽  
Sandra C. Yan ◽  
Timothy R. Smith ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Headache Severity ◽  
Rathke's Cleft

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

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

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

Pituitary ◽  
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

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

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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