Department of Neurosurgery, Faculty of Medicine, Saarland University Medical Center and Saarland University, Homburg, Germany.
Neurosurg Rev. 2024 Aug 5;47(1):403. doi: 10.1007/s10143-024-02545-3.
Resections of symptomatic Rathke's cleft cysts (RCCs) are mainly performed via an endonasal transsphenoidal approach. However, there is a lack of equivalent data in current literature concerning transcranial keyhole approach in the treatment of RCCs. In order to find general recommendations for the surgical treatment of RCCs also with regard to recurrence, the object of this study is the analysis and comparison of both techniques.
Twenty-nine patients having been surgically treated between January 2004 and August 2019 were retrospectively analysed. The transsphenoidal approach was chosen in 16 cases and the transcranial keyhole approach in 13 cases. Both surgical techniques were analyzed and compared concerning preoperative symptoms and cyst characteristics, complications, surgical radicality, endocrinological and ophthalmological outcome and recurrences in patients´ follow up.
The postoperative outcome of both techniques was identic and showed highly satisfying success rates with 92% for neurological deficits, 82% for endocrinological dysfunctions and 86% for visual deficits. In contrast, momentous postoperative complications were significantly more likely after transsphenoidal operations. After a mean follow-up time of 5.7 years, the recurrence rates of both cohorts were the same with 0% each.
Regarding its equal outcome with its lower complication rate, the authors suggest using the supraorbital keyhole approach for RCCs whose anatomical configuration allow both techniques. Yet, the decision should always consider the surgeon's personal experience and other individual patient characteristics. Further studies with higher numbers of cases and longer follow-up periods are necessary to analyse the effect of the selected approach on recurrence.
经蝶窦入路切除症状性 Rathke 裂隙囊肿（RCC）主要采用经鼻内镜经蝶窦入路。然而，目前文献中缺乏关于经颅锁孔入路治疗 RCC 的等效数据。为了找到 RCC 手术治疗的一般建议，包括复发问题，本研究的目的是分析和比较这两种技术。
回顾性分析 2004 年 1 月至 2019 年 8 月间接受手术治疗的 29 例患者。选择经蝶窦入路 16 例，经颅锁孔入路 13 例。比较两种手术技术在术前症状和囊肿特征、并发症、手术根治性、内分泌和眼科结局以及患者随访中的复发情况。
两种技术的术后结果相同，均具有较高的成功率，神经功能缺损为 92%，内分泌功能障碍为 82%，视力障碍为 86%。相比之下，经蝶窦手术术后并发症明显更多。平均随访 5.7 年后，两组的复发率均为 0%。
鉴于其具有相似的效果和较低的并发症发生率，作者建议对于解剖结构允许两种技术的 RCC 采用眶上锁孔入路。然而，决策应始终考虑到外科医生的个人经验和其他个体患者特征。需要进一步进行更多病例和更长随访期的研究，以分析所选方法对复发的影响。
