Treatment Outcomes of Rathke’s Cleft Cysts Managed with Marsupialization

Objectives/Hypotheses: Rathke’s cleft cysts (RCC) are benign cystic lesions of the sella resulting from incomplete obliteration of the space between the anterior and posterior pituitary glands. Symptomatic lesions often require surgical decompression and marsupialization, which in most cases is, amenable to a transnasal, transsphenoidal (TNTS) approach. In this study, we report on our institution’s experience with surgical management of RCC, and describe a novel technique to promote re-epithelization of the marsupialized cyst cavity.

Study Design: Retrospective chart review.

Methods: All patients who underwent TNTS at a tertiary academic medical center for pituitary adenomas found to have RCC on histopathologic analysis between January 1, 2007 and September 1, 2015 were included in the study. Demographics, lesion characteristics, reconstruction, and outcomes are reported.

Results: A total of 52 consecutive patients were identified for analysis. The cohort was comprised of 60% females. The mean age was 41 ± 18 years (range, 13–78). The mean RCC size was 13 ± 5 mm (range, 5–24). Intraoperative cerebrospinal fluid leak was encountered in 14 (27%) cases; all were repaired with fat grafting. There were 5 complications (10%; 3 bleeding, 1 carotid injury, 1 apnea requiring reintubation) and no deaths. The mean follow up period was 20 ± 18 months (range, 1–65), with only 5 (10%) recurrences. 40 (77%) cases were managed by cyst marsupialization. Of note, in 12 cases, the marsupialized cyst cavity was lined with a free mucosal graft to promote healing and re-epithelialization.

Conclusion: The TNTS approach is safe and effective in surgical decompression of RCC. Lining the exposed cyst cavity with a free mucosal graft is a simple intervention without added surgical morbidity that may promote maintenance of an epithelial lined tract to prevent recurrences.