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Ding Z, Lu X, Wang Q, Qian X, Lu H, Xu R, Zhu A. Endoscopic endonasal surgery of Rathke's cleft cysts-- preoperative imaging evaluation, personalized removal and multilevel sellar floor reconstruction. Clin Neurol Neurosurg 2024; 236:108111. [PMID: 38199117 DOI: 10.1016/j.clineuro.2023.108111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effectiveness of endoscopic endonasal surgery (EES) for Rathke's cleft cysts (RCCs) and the advantages of detailed preoperative imaging evaluation, intraoperative personalized removal and multilevel sellar floor reconstruction. METHODS The clinical data of 43 patients with RCCs who were treated by EES in the neurosurgery department of affiliated hospital of Jiangnan University and Wuxi No.2 People's Hospital from January 2018 to January 2023 were retrospectively analyzed. The effectiveness of EES for RCCs was analyzed by imaging information, surgical procedures, symptom improvement and complications. RESULTS All 43 RCCs were completely removed by EES, and all clinical symptoms improved to varying degrees. Postoperative relief of headache was achieved in 23 out of 26 patients (88.5 %); there was improvement in 10 out of 13 patients with visual field disorders (76.9 %) and in 8 out of 10 patients with endocrine abnormalities (80 %). New hormonal deficiency was discovered in 7 of all the patients postoperatively. There were 8 patients with postoperative diabetes insipidus and 1 patient with cerebrospinal fluid leakage. The incidence of new hormonal dysfunction and postoperative DI in expanded EES (33.3 %, 33.3 %) was higher than it in conventional EES (4 %, 8 %) (P < 0.05). The average follow-up time was 29.1 ± 14.8 months, and there were no deaths or infections. Three patients presented with cyst recurrence on MRI. CONCLUSIONS The clinical manifestations and imaging characteristics of RCCs are variable, and a detailed preoperative review of the imaging is helpful for the development of surgical plans. RCCs can be treated more safely and thoroughly with less trauma and complications by intraoperative personalized removal and multilevel sellar floor reconstruction. The high incidence of new hormonal dysfunction and postoperative DI may be related to the disturbance of the pituitary stalk. EES has unique advantages and high clinical application value for the treatment of RCCs.
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Affiliation(s)
- Zhemin Ding
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Xiaojie Lu
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi No. 2 People's Hospital, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Qing Wang
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi No. 2 People's Hospital, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Xinwei Qian
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Hua Lu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Ran Xu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Aihua Zhu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China.
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Lee D, Kim JH, Park DH, Kang SH, Park KJ. Recurrence of Rathke's Cleft Cyst Following Surgery and Histopathological Considerations for Recurrence: A Case Presentation. Brain Tumor Res Treat 2023; 11:266-270. [PMID: 37953450 PMCID: PMC10641313 DOI: 10.14791/btrt.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 11/14/2023] Open
Abstract
Recurrence of Rathke's cleft cysts (RCC) following surgery is not uncommon. We present a 33-year-old male patient with chronic headache and visual disturbances whose MRI showed mostly cystic, suprasellar mass with peripheral enhancement. Endoscopic extended transsphenoidal approach and tumor resection was performed and RCC was pathologically confirmed postoperatively. Early recurrence was first suspected at 3 months following surgery, and his serial MRIs showed a recurred mass without associated clinical symptoms. Upon further histopathological study, extensive squamous metaplasia and high Ki-67 were seen. Also, in this study, we discuss important factors associated with cyst recurrence following surgery.
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Affiliation(s)
- Dongwook Lee
- Department of Neurosurgery, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jang Hun Kim
- Department of Neurosurgery, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Jae Park
- Department of Neurosurgery, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.
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Abstract
The sellar region is a tiny anatomic compartment in which many lesions and developmental diseases can be found. If pituitary adenomas represent most of the sellar mass, it is important to recognize other pathologic conditions before any surgical procedure, because the optimal treatment may differ considerably from one lesion to another. A careful clinical evaluation followed by neuroimaging studies and an endocrinologic and ophtalmologic workup will lead, in most cases, to a diagnosis with near certainty. This article provides an overview of sellar diseases with emphasis on their most useful characteristics for clinical practice.
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Affiliation(s)
- Damien Bresson
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, Paris 75010, France
| | - Philippe Herman
- ENT Department, Lariboisière Hospital, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France
| | - Marc Polivka
- Department of Pathology, Lariboisiere Hospital, 2 rue Ambroise Paré, Paris 75010, France
| | - Sébastien Froelich
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France.
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Paluzzi A, Fernandez-Miranda JC, Pinheiro-Neto C, Alcocer-Barradas V, Lopez-Alvarez B, Gardner P, Snyderman C. Endoscopic endonasal infrasellar approach to the sellar and suprasellar regions: technical note. Skull Base 2012; 21:335-42. [PMID: 22451835 DOI: 10.1055/s-0031-1280682] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a technical variation of the endoscopic endonasal approach to the sellar and suprasellar regions which relies on the use of a 45-degree angled endoscope. The so-called "infrasellar approach" aims at excising lesions situated within the intermediate and posterior lobes of the pituitary gland without damaging the anterior lobe, thus potentially minimizing endocrinological morbidity. In this regard the endoscopic infrasellar approach might be advantageous in selected cases when compared with the traditional transsphenoidal approach with the microscope. We describe the technique and illustrate it with representative clinical cases.
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Lim HH, Yang SW. Risk factor for pituitary dysfunction in children and adolescents with Rathke's cleft cysts. Korean J Pediatr 2010; 53:759-65. [PMID: 21189952 PMCID: PMC3004488 DOI: 10.3345/kjp.2010.53.7.759] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 04/14/2010] [Accepted: 06/03/2010] [Indexed: 12/01/2022]
Abstract
Purpose This study evaluated the clinical manifestations of and risk factors for pituitary insufficiency in children and adolescents with Rathke's cleft cysts. Methods Forty-four patients with Rathke's cleft cysts younger than 19 years who visited Seoul National University Children's Hospital between January 1995 and September 2009 were enrolled. Rathke's cleft cysts were confirmed histologically through an operation in 15 patients and by brain magnetic resonance imaging (MRI) in 29 patients. The clinical, hormonal, and imaging features were reviewed retrospectively. Results The clinical presentation of symptomatic patients was as follows: headache (65%), endocrinopathy (61%), and visual disturbance (19%). Endocrinopathy included central precocious puberty (18%), diabetes insipidus (14%), general weakness (11%), and decreased growth velocity (7%). After surgery, hyperprolactinemia resolved in all patients, but growth hormone insufficiency, hypothyroidism, and diabetes insipidus did not improve. Pituitary insufficiency except gonadotropin abnormality correlated significantly with severe headache, visual disturbance, general weakness, and cystic size. Suprasellar extension of cysts and high signals in the T2-weighted image on brain MRI were related to hypothyroidism, hypocortisolism, and diabetes insipidus. Multivariable linear regression analysis showed that only general weakness was a risk factor for pituitary insufficiency (R2=0.549). Conclusion General weakness is a risk factor for pituitary insufficiency in patients with Rathke's cleft cysts. When a patient with a Rathke's cleft cyst complains of general weakness, the clinician should evaluate pituitary function and consider surgical treatment.
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Affiliation(s)
- Han Hyuk Lim
- Department of Pediatrics, School of Medicine, Chungnam National University, Daejeon, Korea
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