The Supraorbital Keyhole Approach to the Suprasellar and Supra-Intrasellar Rathke Cleft Cysts Under Pure Endoscopic Visualization

Abstract

To evaluate the feasibility of the supraorbital keyhole approach for suprasellar or intrasuprasellar Rathke cleft cysts (RCCs) under pure endoscopic visualization. Thirteen surgically treated patients with symptomatic RCCs were analyzed retrospectively. Preoperative manifestations included headache (77%), visual impairment (38%), polyuria (31%), and pituitary dysfunction (15%). The maximal cyst diameter averaged 29.3 mm (23-46 mm). Eight patients (62%) had a purely suprasellar lesion, and 5 (38%) had a sellar lesion with suprasellar extension. All patients underwent surgery via supraorbital keyhole approach under pure endoscopic view. The mean duration of follow-up was 21.4 months (9-45 months). The cyst content was removed completely in all cases, and the cyst wall was resected partially without transgressing surrounding structures. Preoperative headaches, visual dysfunction, diabetes insipidus, and hypopituitarism resolved in 80%, 60%, 50%, and 50% of patients, respectively. Postoperative complications included transient polyuria in 2 cases and temporary subcutaneous fluid collection in one. No radiological recurrence was observed during the follow-up. The supraorbital approach under pure endoscopic visualization provides a valuable optional minimally invasive access for suprasellar and intrasuprasellar RCCs. This approach combines the advantage of minimal invasiveness and improved visualization while avoiding the risk of cerebrospinal fluid leaks, rhinonasal complications, and gland injury. It is particularly suitable for those cysts with the normal pituitary gland occupying the whole or most part of sellar floor.