Chicago Medical School, Rosalind Franklin University, North Chicago, IL, United States of America.
Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America.
Am J Otolaryngol. 2022 Sep-Oct;43(5):103519. doi: 10.1016/j.amjoto.2022.103519. Epub 2022 Jun 4.
Rathke's cleft cysts (RCCs) are sellar or suprasellar cystic lesions arising from the remnants of the embryological Rathke's pouch. When symptomatic, RCCs are usually treated surgically via marsupialization. Free mucosal graft (FMG) repair has shown promise in decreasing recurrence versus marsupialization alone. The authors present a case report with operative video of a patient with visual and endocrinological symptoms with a RCC treated with FMG following marsupialization. A search of the PubMed database from July 1997 through April 2022 was conducted using the terms 'Rathke's cleft cyst', 'Rathke's cleft cyst management', 'Rathke's cleft cyst repair', 'mucosal graft', 'mucosal coupling', 'transsphenoidal', and 'endoscopic endonasal'. Clinical and pathological aspects of the case presented were compared with information obtained from literature review. A 25-year-old female presented with a six-year history of amenorrhea, one-year history of anemia, headaches, and progressive visual loss. Imaging revealed an RCC. The patient underwent surgical treatment via an endoscopic endonasal approach. Marsupialization was achieved with placement of an FMG to help prevent restenosis. Post-operative examination revealed that the patient's OD vision returned to normal, although her OS vision was only slightly improved. Our review of the English literature resulted in 35 full-length articles that were published between 1997 and 2022. The literature suggests that FMG prevents scar formation by allowing for adequate epithelialization, thus decreasing the recurrence rate and being well tolerated by patients. Our findings support the utility of the FMG as a superior surgical treatment option for RCC management.
Rathke 氏裂囊肿（RCC）是起源于胚胎期 Rathke 氏囊残余的鞍内或鞍上囊性病变。当出现症状时，RCC 通常通过囊袋切开术进行手术治疗。与单纯囊袋切开术相比，游离黏膜移植物（FMG）修复显示出降低复发率的潜力。作者报告了一例患者的病例报告，该患者因 RCC 出现视觉和内分泌症状，在囊袋切开术后使用 FMG 治疗。作者使用术语“Rathke 氏裂囊肿”、“Rathke 氏裂囊肿管理”、“Rathke 氏裂囊肿修复”、“黏膜移植物”、“黏膜连接”、“经蝶窦”和“经鼻内镜”对 1997 年 7 月至 2022 年 4 月的 PubMed 数据库进行了搜索。一名 25 岁女性因六年闭经史、一年贫血史、头痛和进行性视力丧失而就诊。影像学显示 RCC。患者通过经鼻内镜入路接受手术治疗。通过放置 FMG 来实现囊袋切开术，以帮助预防再狭窄。术后检查发现患者的右眼视力恢复正常，尽管左眼视力仅略有改善。我们对英文文献的回顾共得到 35 篇全文文章，这些文章发表于 1997 年至 2022 年期间。文献表明，FMG 通过允许充分的上皮化来防止瘢痕形成，从而降低复发率，并被患者良好耐受。我们的发现支持 FMG 作为 RCC 管理的一种优越手术治疗选择的实用性。
