Rathke's Cleft Cysts: Endoscopic Endonasal Transsphenoidal Approach

Rathke’s cleft cysts (RCCs) are benign, nonadenomatous lesions of the sellar and supra-parasellar areas, which are included in the differential diagnosis with other cystic lesions in such regions, such as craniopharyngiomas, arachnoid cysts, epidermoid cysts, cystic pituitary adenomas, etc.RCCs may remain located within the sella or even extending into the suprasellar space or, conversely, arising as purely suprasellar lesions.Indeed, symptomatic RCCs have historically been felt to be uncommon, determining mass effect on the surrounding structures causing endocrinological and/or neurological dysfunction.Symptomatic patients may present with headaches, visual disturbance, hyperprolactinemia, and/or varying degrees of hypopituitarism, thus requiring surgical removal. The optimal surgical strategy varies according to both clinical status and cyst volume and location (intrasellar/intra-suprasellar cysts Vs. purely suprasellar cysts). With the advent, refinement, and widespreading of the endoscopic endonasal technique for removing pituitary lesion, this technique has been advocated for the treatment of different sellar and suprasellar lesions, including the Rathke’scleft cysts.Thus, lesions that are purely intrasellar or intra-/suprasellar can be removed via a “standard” endoscopic endonasal approach, whereas patients with supraglandular cysts may be candidate to a transtuberculum transplanum “extended” approach. A key point in the surgical management of RCCs is that the simple cyst emptying with a limited removal of any nonadherent cyst wall as specimens for the histopathological diagnosis is usually sufficient to improve or even resolve the preoperative symptoms, mainly related with the mass effect due to the cyst enlargement over time.