Treatment Outcomes of Rathke's Cleft Cysts Managed with Marsupialization

Abstract

<b>Objectives</b> Rathke's cleft cysts (RCC) are benign cystic lesions of the sella resulting from incomplete obliteration of Rathke's cleft. Symptomatic lesions often require surgical decompression, which is often amenable to a transnasal, transsphenoidal (TNTS) approach. We report our experience with marsupialization of RCC and describe a novel technique to promote re-epithelization of the cyst cavity. <b>Design</b> Retrospective review. <b>Setting</b> Tertiary academic medical center. <b>Participants</b> Patients who underwent TNTS for RCC between 2007 and 2015. <b>Main Outcome Measures</b> Demographics, lesion characteristics, and reconstruction and treatment outcomes. <b>Results</b> In total, 52 patients were identified. The mean age was 41 ± 18 years. The mean RCC size was 13 ± 5 mm. Intraoperative cerebrospinal fluid (CSF) leak was encountered in 14 (27%) patients; all were repaired. There were six complications (12%) and no deaths. Mean follow-up was 20 ± 18 months, with five (10%) recurrences. RCC size was associated with intraoperative CSF leak (<i>p</i> = 0.04). In 12 patients, the marsupialized cyst cavity was lined with a free mucosal graft (FMG) to promote healing and re-epithelialization. <b>Conclusions</b> The TNTS approach is safe and effective in surgical decompression of RCC. Lining the exposed cyst cavity with an FMG is a simple intervention without added morbidity that may promote formation of an epithelialized tract. <b>Level of Evidence</b> Not applicable.