Abstract
Objective The main purpose of this article is to address the question of whether reconstructing
the sellar floor following Rathke's cleft cyst excision results in increased rates
of recurrence.
Methods and Design A retrospective case series was compiled from medical records and radiological investigations
at a single institution over a time period spanning 25 years. Episodes of cyst recurrence
were determined from magnetic resonance imaging scans and outpatient encounters. Details
regarding surgical procedure and techniques were obtained from operation notes. Perioperative
morbidity was also recorded.
Results Twenty-three adult patients were treated surgically for a Rathke's cleft cyst at
the study institution between 1992 and 2017. The overall cyst recurrence rate was
48%, with 39% of all patients requiring redo surgery within the timeframe of the study.
The mean time to redo surgery for recurrence was 4 years. Cyst recurrence rates were
57% postmicroscopic procedures, and 26% postendoscopic procedures (p = 0.148). In the nonreconstructed group, the recurrence rate was 17%, and in the
reconstructed group the recurrence rate was 41% (p = 0.3792). Complications arising after nonreconstructive procedures were delayed
cerebrospinal fluid rhinorrhea, pneumocephaly, and multiple episodes of meningitis.
All these patients required return to theater for secondary reconstruction of the
pituitary fossa floor.
Conclusion The results of this small study suggest that reconstruction of the sellar floor,
and microscopic rather than endoscopic techniques, may be associated with a higher
rate of Rathke's cleft cyst recurrence. However, these trends did not reach statistical
significance. Patients undergoing nonreconstructive procedures may be more prone to
certain postoperative complications.
Keywords
Rathke's cleft cyst - recurrence - sellar floor reconstruction - endoscopic - microscopic
