Clinical Features and Surgical Outcomes of Rathke Cleft Cysts with Suprasellar Components: a Single-center Experience of 157 Cases

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 2023 May 10

PMID 37160776

Authors

Ao Qian

Ruichun Li

Jing Zhou

Jiaojiao Yu

Gang Huo

Xiaoshu Wang

Affiliations

Soon will be listed here.

Abstract

Background: Both intrasuprasellar and suprasellar Rathke cleft cysts (RCCs) have suprasellar components, and we aimed to explore their clinical features and surgical outcomes.

Method: Patients with surgically treated intrasuprasellar or suprasellar RCCs were retrospectively analyzed. All patients with intrasuprasellar RCCs were treated with the standard endoscopic endonasal approach (EEA, group I); the patients with suprasellar RCCs received the extended EEA (group II) or supraorbital keyhole approach (SKA, group III) according to the relevant indications. A surgical strategy of maximal safe resection aiming to protect neuroendocrine function was adopted. In addition, patients (distinguished from the above 3 groups) who had aggressive resection of suprasellar RCC were also enrolled for comparison of different surgical strategies.

Results: A total of 157 patients were eligible, including 121 patients with intrasuprasellar RCCs in group I, 19 patients with suprasellar RCCs in group II, and 17 patients with suprasellar RCCs in group III. Preoperatively, the patients with suprasellar RCC (groups II and III) more commonly presented with visual dysfunction, diabetes insipidus (DI), and hyperprolactinemia than the patients with intrasuprasellar RCCs (all p<0.05). A higher incidence of hypopituitarism and a larger diameter were observed for intrasuprasellar RCCs (both p<0.05). Postoperatively, group II had a higher rate of new-onset DI, hyponatremia, and recurrence than group I (all p<0.025) and similar outcomes to group III. For suprasellar RCCs, comparison of the maximal safe resection vs. aggressive resection (supplementary patients: 14 with extended EEA, 12 with SKA) showed similar improvement and recurrence, with higher rates of DI and hyponatremia with the latter strategy (all p<0.05).

Conclusions: Suprasellar RCC is associated with more complicated preoperative presentations, intricate postoperative complications, and frequent recurrence compared with intrasuprasellar RCC. Under rational indications, both extended EEA and SKA achieve satisfactory outcomes. The strategy of maximal safe resection is recommended for greatest functional preservation.

Citing Articles

Rathke's cleft cyst: From history to molecular genetics.

Hacioglu A, Tekiner H, Altinoz M, Ekinci G, Bonneville J, Yaltirik K Rev Endocr Metab Disord. 2025; .

PMID: 39939491 DOI: 10.1007/s11154-025-09949-6.

Natural history and surgical outcomes of Rathke's cleft cysts: a Spanish multicenter study.

Menendez-Torre E, Gutierrez-Hurtado A, Ollero M, Irigaray A, Martin P, Parra P Front Endocrinol (Lausanne). 2024; 15:1413810.

PMID: 38952395 PMC: 11215184. DOI: 10.3389/fendo.2024.1413810.

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