• World Neurosurg · Feb 2025

    SURGICAL STRATEGIES REGARDING THE EXTENDED ENDOSCOPIC TRANSNASAL APPROACH FOR ISOLATED SUPRASELLA RATHKE'S CLEFT CYSTS.

    • Atakan Emengen, Aykut Gokbel, Ayse Uzuner, Eren Yilmaz, OzturkSeda DumanSDDepartment of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey., Hamza Aksoy, Burak Cabuk, and Savas Ceylan.
    • Department of Neurosurgery, Bahcesehir University School of Medicine, Istanbul, Turkey.
    • World Neurosurg. 2025 Feb 6: 123757123757.

    ObjectiveThis study aims to evaluate the clinical and surgical outcomes with suprasellar Rathke's cleft cysts(RCCs) treated using the extended endoscopic transnasal(EET) approach. It emphasizes surgical strategies, nuances of the technique, and the importance of cyst wall resection in optimizing outcomes while preserving postoperative pituitary function.MethodsThis retrospective study analyzed 35 patients with suprasellar RCC who underwent EET surgery between 1997-2024. Data included demographics, symptoms, imaging findings, surgical details, and follow-up outcomes. The suprasellar cyst was classified as preinfundibular, retroinfundibular, and transinfundibular. Hormonal evaluations were performed, and surgical outcomes were classified as gross total resection(GTR) or subtotal resection(STR) based on imaging and intraoperative findings.ResultsThe mean age of the patients was 36.37±14.23 years and female/male ratio was 29:6. Headache is the most common symptom(%77.1). 20 patients had hormonal deficiencies in at least one hypothalamic-pituitary axis. Preinfundibular group is in 21 patients and GTR was achieved in 28(80%). One patient had permanent cortisol and another thyroid deficiency. One patient had persistent postoperative diabetes insipidus. Three patients developed late postoperative the syndrome of inappropriate antidiuretic hormone(SIADH).ConclusionsSurgical intervention is essential for suprasellar RCCs due to their proximity to vital structures. Tailored strategies and gentle resection with minimal stalk manipulation are key to effective treatment and preserving endocrine function.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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