Transsphenoidal resection of 82 Rathke cleft cysts: limited value of alcohol cauterization in reducing recurrence rates.
OBJECTIVE
The aim of this study was to report the results of a large clinical series of patients with symptomatic Rathke cleft cysts (RCCs) who underwent resection by a single neurosurgeon using intraoperative alcohol cauterization, and to review any possible differences in recurrence rates in those treated with this chemically ablative technique.


METHODS
The authors performed a retrospective database review of 82 patients (age range 10-74 years) with symptomatic RCCs who underwent surgery between 1993 and 2009.


RESULTS
Preoperative symptoms of headaches, vision disturbances, and hormone dysfunction were observed in 68%, 35%, and 56% of patients, respectively. All 82 patients underwent treatment by a single surgeon. Surgery consisting of simple cyst drainage followed by cyst wall biopsy without vigorous cyst wall removal was performed. A subset of these patients (62) received intraoperative alcohol instillation. Perioperative complication rates were low: CSF leakage, symptomatic hyponatremia, and permanent diabetes insipidus (DI) in 2%, 5%, and 0% of patients, respectively. Headaches and vision problems improved or resolved in 71% and 83% of patients, respectively. In addition, hyperprolactinemia, hypothyroidism, panhypopituitarism, DI, and adrenal insufficiency improved or resolved in 94%, 90%, 50%, 33%, and 67% of patients, respectively. Recurrence, as defined by enlargement of the cyst as compared with its appearance on baseline 3-month postoperative MR imaging, was noted in 10.7% of the primary surgery group. There was a trend toward increased recurrence rates in the alcohol-treated (12.9%) versus no-alcohol treatment groups (0%), although not statistically significant (p = 0.20).


CONCLUSIONS
This large, single-surgeon/single-institution series of patients with symptomatic RCCs confirms that significant postoperative improvement in headaches, vision, and pituitary hormone dysfunction can be achieved via a conservative surgical approach, with low complication and recurrence rates. The data also demonstrate a limited role for alcohol cauterization in the treatment of symptomatic RCCs.
Lillehei
Kevin O
KO
Department of Neurosurgery, University of Colorado Denver, Denver, Colorado, USA. Kevin.Lillehei@ucdenver.edu
Widdel
Lars
L
Astete
Carolina A Arias
CA
Wierman
Margaret E
ME
Kleinschmidt-DeMasters
Bette K
BK
Kerr
Janice M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002425:Cautery / Q000379:methods*; D020863:Central Nervous System Cysts / Q000473:pathology / Q000601:surgery*; D002648:Child; D016208:Databases, Factual; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*
D000431:Ethanol