Surgical experiences of Rathke's cleft cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach

Abstract

Objective To summarize the surgical techniques of Rathke's cleft cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach and to evaluate its efficacy and the advantages and disadvantages. Methods Twelve patients with Rathke's cleft cyst confirmed by pathology at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from May 2012 to October 2014 were analyzed retrospectively. The clinical manifestations included headache, visual impairment, polydipsia, polyuria, and pituitary dysfunction. CT and MRI revealed the cystic masses in saddle areas. The maximum mean diameter was 29.3 mm, in which 4 lesions were located entirely on the suprasellar areas, and 8 were located on intrasellar suprasellar areas. All patients were treated with cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach. Results The cyst contents were all removed and part of cyst walls were resected in 12 patients. All were pathologically confirmed as Rathke's cleft cyst. The preoperative symptoms of all patients were cured or improved. Two patients had transient polyuria, and they discharged at 3 to 4 days after procedure. They were followed up for 3 to 24 months after procedure. No recurrence was found on imaging examinations. Conclusions The fully endoscopic supraorbital trans-eyebrow keyhole approach is suitable to intrasellar suprasellar Rathke's cleft cyst which is entirely located on the suprasellar area or the main body is located on the suprasellar area. This approach has the advantages of minimal invasiveness, rapid recovery and the absence of cerebrospinal fluid leakage and other complications. The neuroendoscopic technology may further reduce trauma and expand the field of vision, especially beneficial for the observation and removal of intrasellar cyst. Key words: Neuroendoscopy; Central nervous system cysts; Rathke cleft cyst; Trans-eyebrow approach; Keyhole surgery