Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
Neurosurg Rev. 2024 Feb 17;47(1):85. doi: 10.1007/s10143-024-02322-2.
Although patients with symptomatic Rathke's cleft cysts (RCCs) receive surgical treatment, recurrence sometimes occurs after surgery. However, the mechanism underlying recurrence remains unclear. We evaluated the outcomes of RCC decompression over a long-term follow-up period. We retrospectively reviewed the medical records of 35 patients with symptomatic RCC who underwent endonasal endoscopic surgery (EES) at our institution between 2008 and 2023. Patients' characteristics, intraoperative findings, and postoperative follow-up outcomes were evaluated. A univariate regression model was used to identify the predictors of recurrence. The median patient age was 48.0 years, and 74.2% of the patients were female. The mean follow-up duration was 94.7 ± 47.6 months. Cyst content recurrence was observed in 15 patients (42.8%). Five patients (14.2%) with symptomatic recurrence underwent reoperation. Postoperative vision improved in all 23 patients (100%); headaches improved in 20 patients (90.9%). A new hormonal deficit occurred in two patients (5.7%). Complications included intraoperative cerebrospinal fluid (CSF) leak in 10 patients (28.5%), postoperative CSF leak in two patients (5.7%), permanent diabetes insipidus in two patients (5.7%), and postoperative infection in three patients (8.5%). Univariate analyses revealed that the position of the anterior pituitary lobe (p = 0.019) and preoperative visual disturbances (p = 0.008) significantly affected recurrence after surgery. Although EES was efficient, the recurrence rate was relatively high over a long-term period. The anterior pituitary lobe position and preoperative visual disturbances were significantly associated with recurrence. The anterior-inferior position can predict a high risk of recurrence before surgery.
尽管有症状的 Rathke 裂隙囊肿（RCC）患者接受了手术治疗，但手术后有时仍会复发。然而，复发的机制仍不清楚。我们评估了 RCC 减压的长期随访结果。我们回顾性分析了 2008 年至 2023 年间在我院接受经鼻内镜手术（EES）治疗的 35 例有症状 RCC 患者的病历。评估了患者的特征、术中发现和术后随访结果。使用单变量回归模型确定复发的预测因素。患者的中位年龄为 48.0 岁，74.2%的患者为女性。平均随访时间为 94.7±47.6 个月。15 例（42.8%）患者出现囊肿内容物复发。5 例（14.2%）有症状复发的患者接受了再次手术。23 例患者（100%）的术后视力均有所改善；20 例患者（90.9%）头痛症状改善。2 例患者（5.7%）出现新的激素缺乏。并发症包括 10 例患者（28.5%）术中发生脑脊液（CSF）漏，2 例患者（5.7%）术后发生 CSF 漏，2 例患者（5.7%）发生永久性尿崩症，3 例患者（8.5%）发生术后感染。单变量分析显示，术前垂体前叶的位置（p=0.019）和术前视力障碍（p=0.008）显著影响术后复发。尽管 EES 是有效的，但在长期随访中复发率相对较高。垂体前叶的位置和术前视力障碍与复发显著相关。术前下前位置可预测手术前复发的高风险。
