Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Acta Neurochir (Wien). 2023 Aug;165(8):2267-2276. doi: 10.1007/s00701-023-05617-3. Epub 2023 May 10.
Both intrasuprasellar and suprasellar Rathke cleft cysts (RCCs) have suprasellar components, and we aimed to explore their clinical features and surgical outcomes.
Patients with surgically treated intrasuprasellar or suprasellar RCCs were retrospectively analyzed. All patients with intrasuprasellar RCCs were treated with the standard endoscopic endonasal approach (EEA, group I); the patients with suprasellar RCCs received the extended EEA (group II) or supraorbital keyhole approach (SKA, group III) according to the relevant indications. A surgical strategy of maximal safe resection aiming to protect neuroendocrine function was adopted. In addition, patients (distinguished from the above 3 groups) who had aggressive resection of suprasellar RCC were also enrolled for comparison of different surgical strategies.
A total of 157 patients were eligible, including 121 patients with intrasuprasellar RCCs in group I, 19 patients with suprasellar RCCs in group II, and 17 patients with suprasellar RCCs in group III. Preoperatively, the patients with suprasellar RCC (groups II and III) more commonly presented with visual dysfunction, diabetes insipidus (DI), and hyperprolactinemia than the patients with intrasuprasellar RCCs (all p<0.05). A higher incidence of hypopituitarism and a larger diameter were observed for intrasuprasellar RCCs (both p<0.05). Postoperatively, group II had a higher rate of new-onset DI, hyponatremia, and recurrence than group I (all p<0.025) and similar outcomes to group III. For suprasellar RCCs, comparison of the maximal safe resection vs. aggressive resection (supplementary patients: 14 with extended EEA, 12 with SKA) showed similar improvement and recurrence, with higher rates of DI and hyponatremia with the latter strategy (all p<0.05).
Suprasellar RCC is associated with more complicated preoperative presentations, intricate postoperative complications, and frequent recurrence compared with intrasuprasellar RCC. Under rational indications, both extended EEA and SKA achieve satisfactory outcomes. The strategy of maximal safe resection is recommended for greatest functional preservation.
鞍内和鞍上 Rathke 裂囊肿（RCC）都有鞍上成分，我们旨在探讨其临床特征和手术结果。
回顾性分析经手术治疗的鞍内或鞍上 RCC 患者。所有鞍内 RCC 患者均采用标准内镜经鼻入路（EEA，I 组）治疗；根据相关适应证，鞍上 RCC 患者接受扩展 EEA（II 组）或眶上锁孔入路（SKA，III 组）治疗。采用旨在保护神经内分泌功能的最大安全切除手术策略。此外，还纳入了（与上述 3 组不同）行积极切除的鞍上 RCC 患者，比较不同手术策略的效果。
共纳入 157 例患者，其中 I 组 121 例为鞍内 RCC，II 组 19 例为鞍上 RCC，III 组 17 例为鞍上 RCC。术前，与鞍内 RCC 患者（I 组）相比，鞍上 RCC（II 组和 III 组）患者更常出现视力障碍、尿崩症（DI）和高泌乳素血症（均 p<0.05）。鞍内 RCC 患者的垂体功能减退症发生率更高，囊肿直径更大（均 p<0.05）。术后，II 组新发 DI、低钠血症和复发的发生率高于 I 组（均 p<0.025），与 III 组相似。对于鞍上 RCC，最大安全切除与积极切除（补充患者：14 例行扩展 EEA，12 例行 SKA）的比较显示，两种策略的改善和复发情况相似，但后者策略的 DI 和低钠血症发生率更高（均 p<0.05）。
与鞍内 RCC 相比，鞍上 RCC 术前表现更为复杂，术后并发症更为复杂，且复发更为常见。在合理的适应证下，扩展 EEA 和 SKA 均可获得满意的结果。为了最大程度地保留功能，建议采用最大安全切除策略。
