Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China.
Beijing Neurosurgical Institute, Capital Medical University, Beijing, P. R. China.
World Neurosurg. 2022 Nov;167:e146-e156. doi: 10.1016/j.wneu.2022.07.114. Epub 2022 Aug 7.
Rathke cleft cysts (RCCs) are benign lesions originating from remnants of the Rathke pouch. RCCs have been classified into the intrasellar-based or purely suprasellar types. This research aims to study the optimal treatment nuances and evaluate the surgical outcomes of this distinct type of RCCs.
This study retrospectively reviewed 36 patients with purely suprasellar RCCs who were treated by expanded endonasal endoscopic approach (EEA) from September 2018 to January 2021. The demographic data, presenting symptoms, endocrine status, imaging findings, operative details, and surgical outcomes were analyzed.
According to the relationship with pituitary stalk, the suprasellar RCCs can be divided into 2 different growth patterns: intrastalk cyst (ISC, 52.8%) and extrastalk cyst (ESC, 47.2%). Preoperative endocrine dysfunctions occurred more in patients with ISC than ESC (P = 0.007), which are characterized by hypoadrenalism (P = 0.004) and hypogonadism (P = 0.008). Operation exerted different impacts on endocrine functions between ISC and ESC (P = 0.012). When identifying by single hypothalamic-pituitary axis, 4 patients with normal endocrine function developed a new hormonal deficit, 14 patients with preoperative endocrine dysfunctions benefited from our expanded EEA surgical treatment, and 3 of them completely recovered from the endocrinopathy after surgery. The postoperative endocrinopathy was positively associated with the numbers of preoperative abnormal endocrinal axes. Thirty-four (94.4%) patients had achieved gross total resection. Pituitary stalk was intactly preserved in 23 of 36 patients (63.9%), partly preserved in 10 patients, and not preserved in 3 patients.
Purely suprasellar RCCs are a distinct type of RCCs, which originate from the pituitary stalk above the diaphragmatic sellae, and the treatment strategy via expanded EEA is a rational choice. Classification based on growth patterns would be beneficial to reduce endocrine disorders after surgery.
Rathke 裂隙囊肿（RCC）是起源于 Rathke 囊残余的良性病变。RCC 已分为基于鞍内或纯粹鞍上型。本研究旨在研究这种独特类型的 RCC 的最佳治疗细节，并评估其手术结果。
本研究回顾性分析了 2018 年 9 月至 2021 年 1 月期间经扩大经鼻内镜入路（EEA）治疗的 36 例单纯鞍上 RCC 患者的资料。分析了患者的人口统计学资料、临床表现、内分泌状态、影像学表现、手术细节和手术结果。
根据与垂体柄的关系，鞍上 RCC 可分为 2 种不同的生长模式：内突囊肿（ISC，52.8%）和外突囊肿（ESC，47.2%）。ISC 患者术前内分泌功能障碍较 ESC 患者更为常见（P=0.007），其特征为肾上腺功能减退（P=0.004）和性腺功能减退（P=0.008）。ISC 和 ESC 患者的内分泌功能在手术中受到不同的影响（P=0.012）。当按单一下丘脑-垂体轴进行识别时，4 例内分泌功能正常的患者出现了新的激素缺乏，14 例术前存在内分泌功能障碍的患者受益于我们的扩大 EEA 手术治疗，其中 3 例术后内分泌疾病完全恢复。术后内分泌疾病与术前异常内分泌轴的数量呈正相关。34 例（94.4%）患者实现了大体全切除。36 例患者中有 23 例（63.9%）垂体柄完整保留，10 例部分保留，3 例未保留。
单纯鞍上 RCC 是一种独特类型的 RCC，起源于鞍膈上方的垂体柄，通过扩大 EEA 治疗是一种合理的选择。基于生长模式的分类有助于减少术后内分泌紊乱。
