Neurosurgery and Neuroscience

Rathke’s cleft cysts are bengin lesions that originate from congenital remnants of Rathke pouch. The cyst could be filled with different fluids which can affect imaging characteristics. They are frequently found on autopsy, but contrary in rare cases these lesions could exhibit symptomatic growth or present as pituitary apoplexy. 19 patients (eight females) were considered for a non-aggressive surgical strategy of partial cyst wall removal and drainage of cyst contents was performed via endoscopic endonasal transsphenoidal approach (EETA) on all patients. The anterior face of the cyst wall were excised and sent off for pathologic examination. All nineteen procedures were subtotal resections and this was defined as decompression and drainage of cyst contents and partial resection of the ventral cyst wall. Diabetes insipidus resolved for one patient as postoperative complications after six months. There were no postoperative CSF leaks and no permanent neurological or endocrine deficits and all patients had improvement of initial preoperative symptoms. Th e EETA as a non-aggressive strategy for partial cyst wall removal and simple drainage of cyst contents is a feasible approach for surgical treatment of Rathke’s cleft cysts. However, more aggressive strategy may indicated in patients with repeated recurrences. Not to mention that endoscopic approach provides wide panoramic visualization to facilitate extracapsular resection with preservation of pituitary stalk and gland.