title: Third ventricle herniation into the sphenoid sinus following endoscopic transnasal transsphenoidal fenestration of Rathkes cleft cyst.
abstract: Rathke cleft cyst (RCC) is an uncommon albeit benign sellar lesion with an incidence rate of between 2 to 33%. RCCs are usually asymptomatic except in the large cases whit suprasellar extension. We herein describe a unique case of RCC, which presented with severe visual loss owing to massive herniation of the optic chiasm and third ventricle down into the sphenoid sinus through a small 8 x 8 mm foramen after transnasal endoscopic surgical fenestration and marsupialization of the cyst. We describe a reconstruction method via endonasal transsphenoidal approach in this case and suggest prophylactic reconstruction of the sellar floor in sellar lesions with equal or more voluminous suprasellar extensions that are susceptible to such massive herniation and secondary empty sella syndrome.
authors.affiliation: Iran University of Medical Sciences, Hazrat Rasoul Akram Hospital, Endoscopic Pituitary and Skull Base Surgery Unit, ENT-Head and Neck Research Center and Department, Tehran, Islamic Republic of Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Jalessi
authors.forename: Guive
authors.initials: G
authors.lastname: Sharifi
authors.forename: Amin
authors.initials: A
authors.lastname: Jahanbakhshi
authors.forename: Khosro
authors.initials: K
authors.lastname: Parsa
authors.forename: Parin
authors.initials: P
authors.lastname: Yazdanifard
mesh_terms: D001860:Bone Plates; D001927:Brain Diseases / Q000473:pathology*; D020863:Central Nervous System Cysts / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006547:Hernia / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009296:Nasal Cavity / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D009897:Optic Chiasm / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery*; D020542:Third Ventricle / Q000473:pathology*; D014786:Vision Disorders / Q000209:etiology