Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Neurosurg Focus. 2011 Jul;31(1):E2. doi: 10.3171/2011.5.FOCUS1175.
Rathke cleft cysts (RCCs) are benign masses arising from the embryological Rathke pouch, and are commonly treated by transsphenoidal surgery. The authors retrospectively compared RCC extent of resection-either gross-total resection (GTR) or decompression-to the primary outcome measure, which was recurrences resulting in repeat surgery, and the secondary outcome measure, which was complications.
Seventy-four patients presenting to the neurosurgical department with RCC were analyzed retrospectively. Sixty-eight patients had a total of 78 surgical procedures, with the diagnosis of RCC confirmed by histological investigation; of these, 61 patients had adequate operative notes for the authors to evaluate extent of resection. Groups were separated into GTR (32 patients) or decompression (subtotal resection or fenestration into the sphenoid sinus; 29 patients) based on operative notes and postoperative imaging. The mean follow-up duration was 60.5 ± 72.1 months (the mean is expressed ± SD throughout).
The average age at the time of the initial surgery was 42.8 ± 17.4 years, and 70% of patients were female. The mean cyst diameter preoperatively was 16.9 ± 17.8 mm. Eight patients had repeat surgery, our primary outcome measure; 3 repeat operations occurred in the GTR group, and 5 in the decompression group. There was no significant difference in recurrence when comparing groups (GTR 9%, decompression 17%; p = 0.36). There were no major complications; however, analysis of postoperative minor complications revealed that 11 (34%) GTRs resulted in surgical complications, whereas the decompression cohort accounted for only 3 complications (10%) (p = 0.03), with diabetes insipidus (6) and CSF leaks (5) being the most common. Gross-total resection also resulted in an increase in postoperative hyperprolactinemia compared with decompression (p = 0.03).
It appears that RCCs require repeat surgery in 13% of cases, and attempted GTR does not appear to reduce the overall rate of recurrence. However, more aggressive resections are associated with more complications in this series.
Rathke 裂隙囊肿（RCC）是起源于胚胎期 Rathke 囊的良性肿块，通常采用经蝶窦手术治疗。作者回顾性比较了 RCC 的切除范围——完全切除术（GTR）或减压术——作为主要观察指标，即导致再次手术的复发率，以及次要观察指标，即并发症。
对神经外科就诊的 74 例 RCC 患者进行回顾性分析。68 例患者共进行了 78 次手术，RCC 的诊断通过组织学检查得到证实；其中 61 例患者的手术记录足以让作者评估切除范围。根据手术记录和术后影像学检查，将患者分为 GTR（32 例）或减压（次全切除或向蝶窦开窗；29 例）组。平均随访时间为 60.5 ± 72.1 个月（平均值表示为均数 ± 标准差）。
首次手术时的平均年龄为 42.8 ± 17.4 岁，70%的患者为女性。术前囊肿直径平均为 16.9 ± 17.8mm。8 例患者行再次手术，作为主要观察指标，GTR 组 3 例，减压组 5 例。两组复发率无显著差异（GTR 9%，减压 17%；p = 0.36）。无重大并发症；然而，对术后轻微并发症的分析显示，11 例（34%）GTR 导致手术并发症，而减压组仅出现 3 例并发症（10%）（p = 0.03），最常见的并发症为尿崩症（6 例）和脑脊液漏（5 例）。与减压术相比，GTR 还导致术后高催乳素血症的发生率增加（p = 0.03）。
RCC 术后约有 13%需要再次手术，尝试 GTR 似乎并不能降低总体复发率。然而，在本系列中，更激进的切除与更多的并发症相关。
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