Endoscopic Endonasal versus Microscopic Sublabial Transsphenoidal Surgery for Rathke's Cleft Cysts

Objective: The endoscopic endonasal approach has become a popular choice to address various sellar and suprasellar pathologies. A direct comparison of endoscopic endonasal to the microscopic sublabial approach for Rathke's cleft cysts has not been previously studied. We examined patients who underwent surgery for Rathke's cleft cysts between 2010 and 2016 to determine whether an endoscopic surgical approach conferred an advantage when compared with the traditional microscopic sublabial technique.

Methods: We analyzed data from our IRB approved, prospectively collected pituitary surgery database: this study compared Rathke's cleft cyst patients after endoscopic versus sublabial approach with respect to operating time, hospital length of stay, and complications such as diabetes insipidus, SIADH, or bleeding after surgery. The surgical approach was decided based on the availability of ENT for assistance with the approach, not on patient pathology or neurosurgeon preference, thus minimizing bias.

Results: This study evaluated a total of 35 patients (20 female, 15 male, age: 16–78 years) who underwent surgery for treatment of Rathke's cleft cysts. The most common indications were symptomatic mass effect causing visual disturbance and headaches. The surgical approach was endoscopic endonasal in 20 (57%) and microscopic sublabial in 15 (43%). There was no significant difference in operating time ([Fig. 1]; median 73 minutes for the sublabial approach, 85 minutes for endoscopic endonasal). Similarly, the length of stay in the hospital after surgery did not differ between groups ([Fig. 2]; median 37 hours for sublabial approach, 26 hours for endoscopic endonasal). Post-operatively, 2 patients who underwent endoscopic endonasal resection experienced a delayed CSF leak and 2 patients presented to the Emergency Department with epistaxis. Transient posterior pituitary dysfunction was observed in 4 patients, 3 in the endoscopic endonasal group and 1 in the microscopic sublabial group. There was no significant difference in the rate of post-operative complications between groups.

Conclusion: Both surgical methods present equally advantageous options for Rathke's cyst fenestration. Selective use of each technique may vary based on clinician preference, previous training, or current method of practice; however, this study finds no evidence that either approach confers a favorable difference in patient outcomes.

Fig. 1 Operating time by surgical approach.

Fig. 2 Length of stay by surgical approach.

Publication History

Article published online:
15 February 2022