Clinicopathologic Characteristics and Endoscopic Surgical Outcomes of Symptomatic Rathke's Cleft Cysts

BACKGROUND: The purpose of this study was to evaluate the preoperative clinical data and postoperative endocrinologic improvement, recurrence, and complications of Rathke's cleft cysts (RCCs) in a large series of endoscopic transsphenoidal surgery patients, operated in a single center. METHODS: Between 1997 and April 2018, 84 patients underwent endoscopic transsphenoidal surgery for RCCs. The presentation symptoms, endocrinologic results by localization and content of the cysts, surgical resections, postoperative complications, and recurrences were evaluated retrospectively. RESULTS: Chronic headache was reported in 66.6% (56/84), visual field defects were present in 20.2% (17/84), and 23.8% (20/84) of the cases had pituitary dysfunction. Among the endocrinopathies, 17 of 17 patients had hyperprolactinemia, 2 of 7 patients had cortisol deficiency, and 2 of 13 had hypogonadism, which resolved after surgery. Preoperative pituitary hormone deficiency was associated with gelatinous tumor content (P = 0.044). However, there was no significant relationship between tumor localization and preoperative hormone insufficiency. Postoperative hypocortisolemia was seen more frequently in intrasellar RCCs (P = 0.048). Three new pituitary hormonal deficiencies were identified in postoperative patients (1 hypocortisolism, 1 diabetes insipidus, 1 hypogonadism). Gross total resection was achieved in 20 cases (23.8%), 9 of which were performed using an extended approach. Postoperative complications included 3 cerebrospinal fluid leakages and 1 epistaxis. Two patients presented with cyst recurrence at follow-up at 12 and 26 months. CONCLUSIONS: Preoperative hormone deficiency was found to be associated with tumor content, independent of size or localization. The surgical aim for symptomatic RCCs should be decompression and this is effective for endocrinologic improvement. An extended endoscopic approach was adequate for total cyst wall removal in suprasellar cysts. Endoscopic transsphenoidal surgery was successful, with low complication rates, for decompression of intrasellar and suprasellar cysts in both complete cyst wall resection and cyst fenestration.