title: Extended endoscopic endonasal approach for suprasellar Rathke's cleft cysts.
abstract: Purely suprasellar Rathke's cleft cysts (RCC) treated with a microscopic endonasal approach have increased operative morbidity and poorer outcomes compared to purely sellar RCC. We sought to determine if the extended endoscopic endonasal approach improved outcomes for suprasellar RCC. We retrospectively reviewed RCC patients at our institution over a 10 year period comparing outcomes of purely sellar RCC treated microsurgically (n=68), purely suprasellar RCC treated microsurgically (n=22), and purely suprasellar RCC treated endoscopically (n=9). Suprasellar RCC treated endoscopically were similar in size to those treated microscopically (0.9 versus 1.1cm; p=0.4). Complete cyst drainage occurred in 78% of suprasellar RCC approached endoscopically versus 25% approached microsurgically (p=0.02), approaching the 84% complete drainage rate seen with sellar microsurgically approached RCC. Visual normalization occurred in 67% of suprasellar RCC patients treated endoscopically versus 29% treated microsurgically (p=0.5). Headache improved in 71% of suprasellar RCC treated endoscopically, more than the 33% of suprasellar RCC treated microsurgically and the 53% of sellar RCC treated microsurgically (p=0.4). Diabetes insipidus (all temporary) occurred in 22% of patients with suprasellar RCC treated endoscopically, slightly greater than the 14% in suprasellar microsurgical patients and 9% in sellar RCC treated microsurgically (p>0.05). Cerebrospinal fluid (CSF) leak did not occur in any of the suprasellar RCC treated endoscopically, while 14% treated microsurgically experienced a CSF leak (p>0.05). Suprasellar RCC are neurosurgically challenging due to their proximity to the optic chiasm and infundibulum. Compared to microsurgery, endoscopy improves rate of complete removal and visual outcomes.
authors.affiliation: California Center for Pituitary Disorders, Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Jahangiri
authors.affiliation: California Center for Pituitary Disorders, Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Potts
authors.affiliation: California Center for Pituitary Disorders, Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kunwar
authors.affiliation: California Center for Pituitary Disorders, Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Blevins
authors.affiliation: Department of Otolaryngology, University of California at San Francisco, San Francisco, CA, USA; Center for Minimally Invasive Skull Base Surgery, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Ivan H
authors.initials: IH
authors.lastname: El-Sayed
authors.affiliation: California Center for Pituitary Disorders, Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California at San Francisco, San Francisco, CA, USA. Electronic address: AghiM@neurosurg.ucsf.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
mesh_terms: D000328:Adult; D020863:Central Nervous System Cysts / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult
keywords: Endonasal; Endoscopic; Pituitary; Rathke’s cleft cysts; Suprasellar