Radiographic Predictors of Visual, Hormonal, and Surgical Outcomes for Rathke's Cleft Cysts Following Endoscopic Endonasal Surgery

Introduction: Rathke's cleft cysts (RCC) are benign lesions arising from cellular nests of Rathke pouch remnants. This study investigates radiographic predictors of visual impairment, pituitary dysfunction, operative complications, and recurrence of Rathke's cleft cysts.

Methods: Patients aged 18 to 80 years old who underwent endoscopic endonasal surgery at a single institution from 2010 to 2022 for a Rathke's cleft cyst were identified. Forty-five patients met criteria for retrospective chart review according to institutional IRB guidelines. For bivariate analyses, Pearson's chi-squared test or Fisher's exact test was used to compare categorical outcomes, and Wilcoxon tests were used to analyze continuous outcomes. Multivariable analyses used logistic regression to adjust for and identify possible confounding variables. R statistical software (version 4.1.1) was used for all statistical analyses.

Results: Forty-five adult patients were treated using endoscopic endonasal surgery at our institution for RCC. Average and median ages were 39.5 and 34 years respectively, with 73.3% being female. The average follow-up duration was 70 ± 43 months. Visual impairment correlated significantly with larger cyst size. For each millimeter increase in any given dimension of the cyst (e.g., from “10 mm × YY × ZZ” to “11 mm × YY × ZZ”), the odds of visual impairment were 27% higher (p = 0.009). Additionally, females had nearly seven times greater odds of visual impairment compared with their male counterparts of the same age and harboring the same size cyst (p = 0.038). Visual impairment was more frequent in older individuals; with odds 4% greater for each year of life (p = 0.047). The presence of inflammation identified on histopathology increased the risk of pituitary hypofunction by 8.5 times compared with patients with the same degree of T2 intensity on magnetic resonance imaging (p = 0.02). Similarly, for patients demonstrating inflammation on histopathology, odds of pituitary hypofunction with T2 hyperintensity was 13.5 times greater than patients with T2 hypointense lesions (p = 0.009). Intraoperative cerebrospinal fluid (CSF) leakage rates increased by more than 8 times if cysts were larger than 2 cm (50% vs. 16.2% for <2 cm cysts, p = 0.037).

Conclusion: This study examines the impact of multiple radiographic features on rates of visual impairment, pituitary dysfunction, and intraoperative CSF leakage. By carefully considering each factor and the degree to which it adjusts risks, surgeons can more effectively triage patients for surgical urgency and anticipate potential complications.

Publication History

Article published online:
01 February 2023