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J Neurol Surg B Skull Base 2019; 80(05): 505-510
DOI: 10.1055/s-0038-1675558
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Bioabsorbable Steroid Eluting Stents in the Treatment of Recurrent Rathke's Cleft Cyst

Elisabeth H. Ference
1   Rick and Tina Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
,
Karam W. Badran
2   Department of Otolaryngology–Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, United States
,
Edward C. Kuan
3   Department of Otorhinolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, United States
,
Marvin Bergsneider
4   Department of Neurosurgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
,
Anthony P. Heaney
5   Department of Endocrinology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
,
Marilene B. Wang
2   Department of Otolaryngology–Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, United States
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Publikationsverlauf

19. Februar 2018

27. September 2018

Publikationsdatum:
06. Dezember 2018 (online)

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Abstract

Objectives Bioabsorbable steroid eluting stents may prevent the stenosis of ostia after sinus surgery. We describe a technique utilizing this technology to prevent the reformation of Rathke's cleft cysts (RCC) after transnasal transsphenoidal surgical drainage.

Design This study is based on retrospective review.

Setting The research took place at Tertiary academic medical center.

Participants Patients who underwent endoscopic marsupialization of RCC with stent placement were participated in this study.

Main Outcome Measures Demographics, surgical history, outcomes, and complications were primary measures of this study.

Results Four patients underwent drainage of a recurrent RCC with subsequent stent placement. All patients consented to off-label use of the stent. The mean age of patients was 42 years old and the number of prior drainage procedures ranged from 1 to 3. The stent was placed directly into the opening of the cyst after drainage with no other tissue placed into the cyst cavity or opening. The stents are bioabsorbable and were not removed after surgery but were evaluated endoscopically at 2 and 6 weeks after surgery. The patients have been followed for a mean of 14 months after surgery with no evidence of recurrence on endoscopic exam or imaging. No patient had cerebrospinal fluid leak during or after the operation or permanent endocrinopathy.

Conclusion The use of a bioabsorbable steroid eluting stent had no unanticipated consequences and all drainage pathways of all the RCCs remain patent. The use of this technology may decrease recurrence rates in revision or complex cases where patients have extensive scarring of the operative field from prior drainage procedures. Further follow-up of the current cases and study in a larger cohort are warranted.

Keywords

Rathke's cleft cyst - stent placement - skull base - steroid eluting stents - recurrence

Financial Disclosures

The authors have no financial disclosures or conflicts of interest. Of note, none of the authors have or have ever had a consulting or other financial relationship with Intersect ENT.