title: Endoscopic Endonasal Approach in the Management of Rathke's Cleft Cysts.
abstract: OBJECTIVE
  Rathke's cleft cysts (RCCs) are quite uncommon sellar lesions that can extend or even arise in the suprasellar area. The purpose of this study is to evaluate the effectiveness of both standard and extended endoscopic endonasal approaches in the management of different located RCCs.
  
  
  METHODS
  We retrospectively analyzed a series of 29 patients (9 males, 20 females) complaining of a RCC, who underwent a standard or an extended endoscopic transsphenoidal approach at the Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, of the Università degli Studi di Napoli "Federico II". Data regarding patients' demographics, clinical evaluation, cyst characteristics, surgical treatments, complications and outcomes were extracted from our electronic database (Filemaker Pro 11, File Maker Inc., Santa Clara, California, USA).
  
  
  RESULTS
  A standard transsphenoidal approach was used in 19 cases, while the extended variation of the approach in 10 cases (5 purely suprasellar and 5 intra-suprasellar RCC). Cysts contents was fully drained in all the 29 cases, whilst a gross total removal, that accounts on the complete cyst wall removal, was achieved in an overall 55,1% of patients (16/29), specifically 36,8% (7/19) that received standard approach and 90% (9/10) of those that underwent to extended approach. We reported a 56.2% of recovery from headache, 38.5% of complete recovery and 53.8% of improvement from visual field defect and an overall 46.7% of improvement of the endocrine functions. Postoperative permanent DI rate was 10.3%, overall post-operative CSF leak rate 6.9%; recurrence/regrowth occurred in 4 patients (4/29, 13.8%), but only one required a second surgery.
  
  
  CONCLUSIONS
  The endoscopic transsphenoidal approach for the removal of a symptomatic RCC offers several advantages in terms of visualization of the surgical field during both the exposure and removal of the lesion. The "extended" variation of the endoscopic approach provides a direct access to the supradiaphragmatic space, allowing adequate view and room for the safe removal of selected supradiaphragmatic RCCs, regardless of the sellar size (even a not enlarged sella), and provides a higher likelihood of preserving normal pituitary tissue and functions.
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Cavallo
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Somma
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Chiaramonte
authors.affiliation: Department of Neurosciences, Division of Neurosurgery, Università degli Studi di Messina, Messina, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Department of Biomorphological and Functional Sciences, Division of Pathology and Cytopathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Marialaura
authors.initials: M
authors.lastname: Del Basso De Caro
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
mesh_terms: D000293:Adolescent; D000328:Adult; D020863:Central Nervous System Cysts / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies